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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.
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VIVELLE-DOT (estradiol transdermal system) IS AVAILABLE BY PRESCRPTION ONLY.
INDICATION
Vivelle-Dot is used after menopause to: reduce moderate to severe hot flashes; treat moderate to severe dryness, itching and burning in or around the vagina; help reduce your chances of getting osteoporosis (thin weak bones); and treat certain conditions in which a young woman's ovaries do not produce enough estrogens naturally. Vivelle-Dot 0.025 mg/day is only used to prevent osteoporosis from menopause. If you use Vivelle-Dot only to treat your dryness, itching, and burning in and around your vagina or if you use Vivelle-Dot only to prevent osteoporosis from menopause, talk with your healthcare professional about whether a different treatment or medicine without estrogens might be better for you.
IMPORTANT SAFETY INFORMATION
Estrogens increase the chances of getting cancer of the uterus (womb). Report any unusual vaginal bleeding right away while you are taking estrogens. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb).
Do not use estrogens with or without progestins to prevent heart disease, heart attacks, or strokes. Using estrogens with or without progestins may increase your chances of getting heart attacks, strokes, breast cancer, and blood clots. Using estrogens with progestins may increase your risk of dementia (decline in memory and thinking skills).
Vivelle-Dot should not be used if you have unusual vaginal bleeding; currently have or have had certain cancers, including cancer of the breast or uterus; had a stroke or heart attack in the recent past (for example, in the past year); currently have or have had blood clots; currently have or have had liver problems; or think you may be, or know that you are, pregnant.
The most common side effects that may occur with Vivelle-Dot are headache, breast tenderness, and back pain.
You and your healthcare professional should talk regularly about whether you still need treatment with Vivelle-Dot.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see Full Prescribing Information for Vivelle-Dot.
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