Alternatives to HRT

Last Editorial Review: 1/31/2005

Quelling Heart Disease, Stroke, Osteoporosis, Hot Flashes, and More

By Jeanie Lerche Davis
WebMD Feature

Reviewed By Brunilda Nazario

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 The Lancet.

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.


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.

Also, eating more protein could help the body to more effectively absorb calcium/vitamin D supplements, according to one recent study at Tufts University in Boston. Elderly people who took 500 mg supplements in addition to dietary calcium -- and ate about 80 grams of protein a day -- had better bone mass than those in the control group.

And remember, 30 minutes of weight-bearing and strength-training exercise -- even for women in their 70s, 80s, 90s, and older -- can build bone.

However, the nutritional supplement ipriflavone -- a synthetic isoflavone derivative -- does not have an effect on bone density, according to a study in the March 21, 2001, issue of The Journal of the American Medical Association. Isoflavones are found in soy products.

Hot Flashes, Night Sweats, Mood Swings

Soy may be an effective treatment to quell hot flashes and night sweats. Though there have been many studies on soy, the results have been conflicting.

Growing evidence finds that black cohosh, on the other hand, is effective in controlling these menopausal symptoms. Several studies published this year found evidence in favor of black cohosh, which is an herb and an ancient Native American remedy for hot flashes.

One three-month study of 976 postmenopausal women found that 40 mg of black cohosh daily reduced their symptoms significantly -- hot flashes, mood swings, night sweats, insomnia -- compared with controls; those findings were presented at this year's meeting of The Endocrine Society. Another study of black cohosh extract, marketed as Remifemin, reduced symptoms in 70% of women. The study was published in the March 28 The Journal of Women's Health and Gender-Based Medicine.

However, another review of literature on black cohosh and soy found that research is limited and inconclusive and suggests that physicians not recommend either until there is more evidence.

Antidepressants -- including Prozac and Effexor -- have been shown to cool hot flashes. One study, published in the Journal of Clinical Oncology, looked at how well Prozac reduced hot flashes in 81 women with a history of breast cancer. Those taking Prozac reported 50% fewer hot flashes compared with a 36% reduction among women taking a placebo.

Women can also reduce hot flashes by:

  • Dressing in layers, so they can remove clothes as needed.
  • Wearing natural fabrics, such as cotton and silk.
  • Keeping room temperatures cool or using a fan.
  • Sleeping with fewer blankets.
  • Drinking cold beverages rather than hot ones.
  • Limiting intake of caffeine and alcohol.
  • Eating smaller meals.
  • Not smoking.
  • Using relaxation techniques such as yoga.
  • Getting regular exercise.

Lost Libido

A liquid that heightens sexual sensation when spread on the genitals -- alprostadil -- may help women who have lost that lovin' feeling. The liquid is made with prostaglandin E, a naturally occurring substance that has been used for years to treat erectile dysfunction in men. It worked for postmenopausal women in one study: those given alprostadil had increased blood flow to the genitals after applying the liquid while few of the women who used a placebo did; all then watched erotic videos for 30 minutes.

Voila: The women who used alprostadil said they had a "high" or "very high" level of sexual arousal and satisfaction. Some women actually had spontaneous orgasms during the experiment.

Vaginal Dryness

Known medically as atrophic vaginitis, vaginal dryness happens to all women to some degree as they age -- but for some, it's a major quality-of-life problem affecting sex life. Among the remedies:

  • Sexual activity, including masturbation and intercourse, maintains a woman's ability to lubricate.
  • KY Jelly, Astroglide, and Replens are better over-the-counter lubricants than oil-based petroleum jelly, and can be used safely with condoms.
  • Prescription estrogen creams allow estrogen to be absorbed at the vaginal opening, and absorbed into the bloodstream.
  • New products are also available, including one called Vagifem that is inserted into the vagina. Estring is a ring inserted high into the vagina that slowly releases estrogen for about three months; it is then removed and replaced.
  • Vitamin E oil -- obtained from cracking open a vitamin E capsule -- can also be used directly in the vagina to increase lubrication and soothe the vaginal lining.

Published July 10, 2002.

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