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Menopause: Is There Life Beyond Hormone Replacement Therapy?

Post-HRT, what are women doing to manage menopause symptoms? And are compounded bioidenticals safe?

Nonhormonal treatments for menopause

Millions of women remain leery of any type of drugs and choose not to use either HRT or birth control pills. After doing her menopause homework, Richardson opted for a solution with only lifestyle changes. “I created a plan to maintain my health and deal with menopausal symptoms naturally.” Starting an exercise program helped control hot flashes and weight gain, Richardson says. She began working out at the gym after years of hectic 60-hour workweeks that left little time for exercise. “It alleviated a lot of my symptoms.”

Avoiding extreme changes in temperature, layering clothing, and saying no to both caffeine and spicy foods are other ways to help with hot flashes. So is reducing stress through meditation or deep breathing, say experts.

What about alternative treatments for hot flashes, such as black cohosh or soy products? They may be worth a try, but aren’t strong bets for everyone, says Margery Gass, MD, director of the University Hospital Menopause and Osteoporosis Center at the University of Cincinnati.

“When you look at a critical review of all the studies, none of them have turned out to be highly effective,” she says of alternative menopause products. “But that does not mean that, on an individual level, one particular person might not benefit. If people want to try those products, they just need to keep an open mind and consider a one-month trial to see if there’s any benefit.” But women should inform their doctors about what they’re taking, she adds. 

Are bioidenticals the answer?

You may have heard that Oprah Winfrey’s taking “bioidenticals” for menopause relief. And Suzanne Somers endorses them in her books and on TV. But are they safe?  

Bioidentical hormones are chemically derived from extracts found in yams or soy. For many years, doctors have prescribed clinically tested, FDA-approved, bioidentical hormone drugs, such as pharmaceutically manufactured estrogen patches, pills, creams, and natural progesterone, to ease menopause symptoms.

But these aren’t the products generating the current buzz -- and controversy. In recent years, Somers and other celebrities have promoted these compounded bioidentical hormones as safer, more effective, and more natural than synthetic hormones.

That’s not necessarily the case. Consider:

Bioidenticals aren’t FDA approved. The drugs are mixed to order, so there is no testing of their efficacy or safety. Compounding pharmacies do use some of the same ingredients found in FDA-approved products. However, their compounded bioidentical mixtures are not FDA-approved or regulated. They may even pose potentially serious side effects.

Bioidenticals may have side effects. “Don’t go in thinking these things are totally risk-free and that there’s tons of data,” says Mary Jane Minkin, MD, an obstetrician and gynecologist who fields numerous requests from patients, yet urges them to steer clear of these unregulated drugs. Both doctors express frustration, though, that their warnings are often drowned out by the chorus of endorsements from celebrities and others with no medical training.

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