Menopause: Estrogen Alternatives

by Food and Drug Administration (FDA)

(Page 3 of 3)

Other plant-derived estrogens approved for menopausal symptoms include Alora (estradiol), Climara (estradiol), FemPatch (17-beta-estradiol), Menest (esterified estrogens), Ortho-est (estropipate), Vivelle (estradiol), and Ogen (estropipate). Estrace (estradiol), Estraderm (estradiol), and Estratab (esterified estrogens) are plant-based estrogens approved for both menopausal symptoms and osteoporosis prevention. Estrogen/progesterone combinations also are available in either patch or pill form.

Relief from vaginal atrophy can be attained with a variety of FDA-approved vaginal creams containing estrogen, such as Estrace (estradiol), Ortho Dienestrol (dienestrol), Premarin (conjugated estrogens), and Ogen (estropipate). Estring (17-beta-estradiol), a vaginal ring, also is available. The ring is inserted into the upper vagina, where it provides a consistent low dose of estrogen for three months. Since only a small amount of the hormones provided by the ring and creams is absorbed into the system, they are not believed to increase the risk for endometrial or breast cancer. Estradiol rings do not alleviate symptoms such as hot flashes, and are not believed to provide protection against menopause-related diseases such as osteoporosis and heart disease.

Estrogen Alternatives

In 1997, FDA approved Evista (raloxifene), a drug that mimics estrogen's protective effects on the bones and heart. Clinical studies show that this drug, one of a new class called selective estrogen receptor modulators (SERMs), increases bone density and reduces levels of LDL, or "bad" cholesterol. But it does not cause the endometrial buildup or breast changes that may increase cancer risk. It does carry the risk of blood clots and is not effective for menopausal symptoms such as hot flashes. More studies are in progress to determine the long-term effects and efficacy of Evista and other SERMs.

Miacalcin (calcitonin) and Fosamax (alendronate) are two drugs FDA has approved for treating osteoporosis. Miacalcin is effective in women who are not candidates for HRT and who are at least five years postmenopausal and are suffering from osteoporosis. Available as a nasal spray, it has been found to increase bone density.

Fosamax reduces the activity of the cells that cause bone loss and thereby increases the amount of bone present. Both drugs can cause side effects, making a consultation with a physician essential.

Some women may prefer to "let nature take its course" and choose not to take prescription hormones. Others turn to alternative remedies touted to relieve menopausal symptoms and protect against related diseases.

One type of foods being extensively researched are "phytoestrogens." These are natural compounds similar in chemical structure to estrogen that may produce estrogen-like effects in menopausal women.

Of these compounds, the isoflavones found in soy protein seem to be the most promising. Studies being conducted at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., show the phytoestrogens in soy protein to be just as effective as Premarin in monkeys at limiting the formation of atherosclerosis, a major cause of heart disease. Additionally, women who added 20 grams of soy protein to their diets reported less intense menopausal symptoms, such as hot flashes and night sweats.

"We believe soy may offer many of the benefits of estrogen replacement therapy without the risks," says study leader Greg Burke, M.D.

The benefits of soy protein first drew interest when studies showed that in Asian countries, where diets are high in soy, both the incidence of breast cancer and the heart disease mortality rate are four times lower than in the United States. In addition, Asian women report fewer hot flashes and night sweats during menopause. These women get about 30 to 50 milligrams of isoflavones daily, the levels found in half a cup of soy milk or tofu or a quarter cup of roasted soy nuts.

In 1998, FDA proposed allowing health claims about the role soy protein may play in reducing the risk of heart disease on the labels of foods containing soy protein. Studies show that 25 grams of soy protein per day may lower blood cholesterol levels.

Be Prepared

Making some lifestyle changes can help women increase longevity and avoid the health risks associated with menopause. The American Heart Association recommends limiting total fat intake to no more than 30 percent of calories, cholesterol to no more than 300 milligrams daily, and salt to no more than 3,000 milligrams daily. The association also recommends eating lean meats, low-fat dairy products, and at least five servings of fruits and vegetables daily.

In addition to a heart-healthy diet, exercise that includes cardiovascular and weight-bearing workouts is good for the heart and bones. The action of muscle on bone helps to increase bone density, so exercises such as weight training, running, walking, or jogging are important. Check with a doctor before beginning an exercise program.

"Preparing for the change of life is essential, since women are living one third or more of their lives in menopause," says Richter. "Together with their physicians they can minimize the associated health risks and help sustain a good quality of life throughout their nonreproductive years."

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.