Encyclopedia of Health and Medicine

302 The Reproductive System
withdrew recommendations for routine long-term
HRT, advising that doctors instead prescribe timelimited
hormone supplementation to relieve
menopausal discomforts only when they interfered
with a woman’s QUALITY OF LIFE. Under the
current standard of practice guidelines most
women should not take hormone supplementation
for longer than two years, with a trial off the
supplementation every six months to assess
whether it remains necessary. Each woman’s individual
health circumstances require her doctor’s
careful evaluation to determine whether hormone
supplementation is appropriate.
There is a sizable group of health-care professionals
who prescribe BIHRT (bio-identical hormone
replacement therapy). BIHRT utilizes
hormones such as estradiol, progesterone, and
testosterone that are chemically identical to those
found in the woman’s body. It is felt by many that
not only do they not pose the same health risks as
were identified in the WHI study but do actually
provide numerous health benefits.
Nonhormonal approaches Selective serotonin
reuptake inhibitors (SSRIs), a class of ANTIDEPRES-
SANT MEDICATIONS, have emerged as effective therapies
to relieve hot flashes. Doctors usually
prescribe these medications at doses lower than
those typically used to treat depression.
Researchers do not know the precise mechanisms
through which SSRIs relieve hot flashes.
There are numerous alternative or complementary
approaches to relieve menopausal discomforts,
some of which show evidence of their
success through clinical studies. Among them
include ACUPUNCTURE, SOY, and the medicinal herb
BLACK COHOSH, all to relieve hot flashes, and wild
yam cream to relieve vaginal dryness. Soy and
black cohosh contain PHYTOESTROGENS, plant-based
substances that are similar to human estrogens
and bind with estrogen receptors in the body,
though with less intensity than endogenous estrogens.
Wild yams contain a plant-based form of
progesterone.
Other remedies are widely believed to provide
relief but lack evidence, either because studies
have not been done or have produced inconclusive
or conflicting results. Among these are black
cohosh to relieve mood swings and irritability and
DONG QUAI, soy, and red clover to relieve hot
flashes and other discomforts. Evening primrose
oil and vitamin E supplements appear to help with
relaxation and sleep.
ACUPUNCTURE
DONG QUAI
red clover
vitamin E
ALTERNATIVE REMEDIES
TO TREAT MENOPAUSAL DISCOMFORTS
BLACK COHOSH
evening primrose oil
SOY
progesterone cream
Changes That Occur with Menopause
Estrogen has multiple and powerful actions in a
woman’s body and the decline of its presence after
menopause results in changes that affect all body
systems. One such action is a diminished ability to
repair collagen structures in the body such as ligaments,
tendons, and the SKIN. The loss of collagen
may affect the ligaments in the abdomen that support
the UTERUS, particularly in women who have
given birth, resulting in UTERINE PROLAPSE. A good
number of women experience URINARY INCONTI-
NENCE as a result of weakening of the muscles that
control the flow of URINE; KEGEL EXERCISES often
improve or prevent this. The skin thins and
becomes less elastic, resulting in wrinkles. Sebaceous
secretions also diminish, causing the skin to
become dry. The mucous lining of the VAGINA thins
as well, resulting in reduced vaginal secretions.
The more fragile vagina may produce symptoms
such as burning and itching (VAGINITIS) and discomfort
during SEXUAL INTERCOURSE.
Changes in collagen also affect the walls of the
arteries, causing them to become less flexible and
less able to relax (dilate). As well, estrogen plays a
key role in the METABOLISM of cholesterol and fatty
acids. As estrogen levels drop the body handles
these lipids less efficiently. Consequently HYPERLIPI-
DEMIA, ATHEROSCLEROSIS, and HYPERTENSION (high
BLOOD PRESSURE) become more common after
menopause. In addition, loss of estrogen (specifically
estradiol) can contribute to HYPOTHYROIDISM
and increased CORTISOL potentially leading to
INSULIN RESISTANCE. Estrogen also acts as a natural
selective serotonin reuptake inhibitor (SSRI) so its
loss contributes to increased DEPRESSION. Nutritious
EATING HABITS and daily physical exercise become
especially important to maintain cardiovascular
health in light of these changes.