Alternatives to HRT

Women are having second thoughts about hormone replacement therapy -- but what are the options? How can women protect heart, brain, breasts, and bones from the ravages of age sans estrogen? And what about hot flashes, night sweats, lost libido, vaginal dryness?

Well, there definitely are options -- some more effective than others. Here's a capsule version of the latest findings:

Heart Disease and Stroke

A powerful class of drugs called statins reduce the amount of cholesterol in the blood -- especially LDL, the so-called "bad" cholesterol. Statins have also been found to reduce stroke, may reduce osteoporosis, could be an adjunct treatment for cancer.

Risk of heart-related deaths in 20,000 men and women (ages 40-80) was reduced by 18% among those who received statins. People who took statins were also 25% less likely to suffer a nonfatal heart attack or stroke or require bypass surgery. That study appeared in the July 6 issue of TheLancet.

Statin use was linked with 22% reduction of all strokes and 25% reduction in nonfatal strokes in another study published in the Jan. 23 issue of Circulation: Journal of the American Heart Association.

Studies of soy protein show varying results in reducing blood pressure and LDL cholesterol in postmenopausal women. Though at least one small study found reductions when patients ate natural soy, other studies did not show improvements from soy extracts. Researchers conclude that different proteins found in natural soy appear to interact with phytoestrogens -- plant estrogens -- to increase their cholesterol-lowering activity. Those studies were discussed at last year's Endocrinology Society meeting.

Limiting salt in the diet -- and walking 30 minutes a day -- can also lower blood pressure in postmenopausal women by a surprising amount, according to a study published in the August 2001 Journal of the American College of Cardiology. In the study, those who ate only a teaspoon of salt a day plus walked lowered their blood pressure by 16 points. To lower sodium in diet, cook with less salt, use herbs and lemon juice to flavor foods, check packed food labels for sodium, and limit salty snack foods.

Osteoporosis

Fosamax and similar bisphosphonate medications are designed to prevent or treat osteoporosis; they slow bone thinning and increase thickness of the bones of the spine and hip. This reduces the risk of broken bones. The drugs are so successful that researchers are now looking at administering the drug through annual intravenous infusions -- so women don't have to take pills every day.

Evista, which belongs in a separate class of drugs, also is prescribed to prevent and treat osteoporosis. Evista has another plus -- it has a favorable effect on cholesterol but does not increase the risk of breast or uterine cancer.

Calcium and vitamin D supplements -- to the tune of 1,500 mg a day -- are recommended for older women and men. Dietary sources of calcium include fat-free milk, yogurt, and cheese.