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Menopause and HRT


Non-Hormonal Conventional Treatment

Hot Flashes

Vaginal Dryness, Painful Intercourse, And Painful Urination

Bone Loss

Hot Flashes


Several anti-hypertensive drugs can relieve menopausal hot flashes. But they have severe side effects such as, fatigue and dizziness. If you have severe flashes but no other recourse for treatment, or if you have hot flashes as well as high blood pressure, generics such as clonidine might be appropriate for you. It is thought that these drugs work by exerting a stabilizing effect on the hypothalamus, the body's thermostat.

Clonidine is shown to alleviate flushing by 30 to 40 percent. It comes in pill form or as skin patches. The normal dose is 0.1 and 0.2 mg twice daily. A physician may begin treatment with a lesser dose (0.05 mg twice daily), hoping to both quell hot flashes and keep side effects at bay.

Inderal, aldomet, and veralipride also are used for menopausal hot flash reduction, as are beta-blockers such as sotalol. None of the above-mentioned drugs has FDA approval for this treatment use.


Bellergal, the brand name for a mixture of phenobarbital, belladonna, and ergotamine tartrate, has been shown to reduce hot flashes by 50 percent and has FDA approval for the treatment of menopausal hot flashes. Unfortunately, its barbiturate components can cause addiction. Side effects include dry mouth, fatigue, and depression. Because of its addictive properties, Bellergal isn't usually recommended for hot flashes, and if used should be restricted to the short term.

Vaginal Dryness, Painful Intercourse, And Painful Urination

Non-hormonal Vaginal Moisturizers

Several over-the-counter vaginal lubricants can help women overcome vaginal dryness, painful intercourse, and painful urination due to estrogen depletion. Make sure that the moisturizer you choose is water soluble, since those that aren't (petroleum jelly, for in- stance) create a moisture barrier that works against lubrication. Certain of these products are used only at the time of intercourse, while others are designed for more continuous relief of vaginal dryness.

Non-hormonal creams can relieve vaginal dryness more rapidly than estrogen creams. But since they contain no estrogens, they won't stimulate a cellular buildup of vaginal tissue over time. Therefore, for a continuous reduction of vaginal dryness, you'll need to keep reusing the recommended dosage continuously. In comparison, estrogen cream doses can often be reduced as vaginal dryness abates. Vaginal lubricants aren't as effective as vaginal estrogens in controlling urinary tract infections. Yet they can help maintain a pH level that thwarts infection.

Most over-the-counter vaginal moisturizers work short- term, at the time of use. Polycarbophil, the active ingredient in the product Reptens, represents a novel effort toward continuous treatment of vaginal dryness. Its bio- adhesive delivery system draws water out of cells into the vaginal area. Hence the body's own fluids lend to continuous lubrication. Unfortunately, Replens is very expensive. It's usually used three times a week. Other effective over-the-counter moisturizers include Astroglide (a gel) and Lubrin (a suppository).

Functional Electrical Stimulation

This approach uses a vaginal probe to deliver short bursts of electrical current through the vaginal wall to pelvic muscles, causing pelvic muscles to contract and, over time, strengthen. Some reports state that electrical stimulation can significantly reduce incontinence, although the full benefits of this technique need further review. The procedure is usually performed on a daily basis for several weeks.

Collagen Implants

Recently approved by the FDA for specific causes of stress urinary incontinence, this procedure involves the use of collagen, a protein found in humans and animals. When collagen is injected into tissue around the urethra, it can build up tissue bulk. This provides more pressure around the urethra so that if intra-abdominal pressure increases because of a cough or sneeze, it will be counteracted by the collagen, and thus urine will not leak out. This technique reportedly has a 50 to 75 percent success rate.

Medications and Surgery for Incontinence

No safe and effective drugs are available for relief from stress incontinence. A few medications can improve urge incontinence for certain women. The antidepressant imipramine, for example, relaxes the bladder, which can serve to make the pressure of the urethra greater than the pressure in the bladder, preventing leakage. Imipramine's side effects (dry mouth, dizziness), however, may limit its use. Ditropan (brand name), an antispasmodic, is also used to treat incontinence, although users may experience diarrhea, drowsiness, blurred vision and other side effects.

If stress incontinence is severe, many different types of surgery can be attempted. The general goal is to restore the structural relationship between the urethra, urthrovesical junction, bladder, and other pelvic organs. However, surgery can also create new bladder-related disorders, including urge incontinence and voiding problems. If surgery is undertaken, the drawbacks that might arise may still seem more manageable than what a woman was experiencing beforehand.

For Bone Loss

Some of the treatments included here use hormones derived from the thyroid and parathyroid glands. These hormones aren't considered "hormone replacement" therapies since they aren't replacing ovarian- made hormones. Their use does not appear to create the cancer-related risks cited for erogenous estrogens.

Prescription Drugs

Replacement estrogens and calcitonin are the only medications approved by the FDA for the treatment of bone loss. Other therapies (including those described here) should be considered experimental


A hormone made by the thyroid gland, calcitonin is known to inhibit bone resorption, the process by which bone is broken down and reabsorbed in the body. There's indication that it also regulates calcium metabolism. When used as a treatment, calcitonin has been shown to slow bone loss and may improve bone density. However, it does not decrease fractures in post- menopausal women the way replacement estrogens have been shown to do. This treatment may be most beneficial to those who have a high bone turnover with rapid bone loss.

Form: Injection, Nasal spray

Side Effects: Less than 10% experience flushing, nausea, and dizziness. These can be minimized by taking the drug at bedtime.

Very expensive.

Nasal spray is sprayed in one nostril one day and the other nostril the other day.


The bisphosphonates are synthetic compounds made out of phosphorous and carbon. When incorporated into bone, they inhibit bone resorption and may reduce the vertebral fracture rate. While these compounds can work as a successful short-term therapy for postmenopausal bone loss, their longer-term effects on osteoporosis aren't yet known.

The bisphosphonate most in use for treating bone disorders is etidronate (generic name), a drug which has federal approval for the treatment of Paget's disease and high levels of calcium in the blood due to cancer (hypercalcemia).

Initial studies suggest that an effective regimen consists of taking etidronate daily (400 mg) for two weeks every three months, with calcium (1,000 to 1,500 mg) taken daily when the drug isn't being taken.

Poorly absorbed. Take in an empty stomach.

Side Effects: No significant side effects were observed when treating bone loss.

Less expensive than calcitonin.


A new drug called Fosamax (alendrinate) shows promise in treating women who already have osteoporosis. In a five-year study, women with low bone density were able to increase their bone density with daily doses of Fosamax..

Poorly absorbed from the intestines, take on an empty stomach, first thing in the morning with a glass of water and then wait a half hour before eating anything.

Side Effects: esophageal ulceration, so don't lie down directly after taking the medication.

Parathyroid Hormones

This treatment carries the unique potential of activating new bone growth, according to researchers, unlike other available treatments, which mostly retard bone loss. Parathyroid hormone is produced in four small glands located behind the thyroid gland. When low doses of parathyroid hormone are administered intermittently by once-a-day injections, the result is the stimulation of bone-forming cells (osteoblasts) and an increase in bone mass. In human studies, this approach has consistently resulted in significant increases in trabecular bone (the spongy, inner part of bone) of the spine. Few changes in cortical bone (the outer, more dense part of bone) have been observed.

Next Topic: Hormone Replacement Therapy (HRT)

                 Alternative and Natural Approaches to the treatment of Menopause

                Natural Hormone Replacement Therapy: Delivery Systems

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