date: 11/23/2005
Relieving the symptoms of menopause: Do you need hormones?
This article is a summary of our complete report on relieving the symptoms of menopause, available at ConsumerReportsBestBuyDrugs.org.
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The female hormones estrogen and progestin have been
used for more than 20 years to treat the symptoms of menopause. In 2002
this treatment became controversial after a study showed that it increased
the risk of heart disease and some cancers. Millions of women stopped taking
the drugs.
But if you have debilitating menopause symptoms (hot flashes, night sweats, disturbed sleep, and vaginal dryness), you may still want to consider hormone treatment. Low doses used for a short period are now common practice for women with severe symptoms and may be quite safe, although the research on that use is not yet conclusive.
A new report from Consumer Reports Best Buy Drugs, based on the latest scientific research, will help you talk to your doctor about whether you need hormone treatment, and if so, which drugs may be the best. The full report is available free at www.CRBestBuyDrugs.org or by clicking here.
The report makes the following overall recommendations:
Although the increased risk posed by hormones (of heart disease, breast cancer, stroke, blood clots, and dementia) is relatively small, the danger is that it could add to existing risk factors for tens of millions of women.
For example, a woman who has high blood pressure and diabetes is already at elevated risk for heart attack and stroke. Taking hormones adds to that risk. Similarly, a woman who has high cholesterol and a family history of early heart disease and breast cancer would add to existing elevated risk if she took hormones.
As for women who have mild symptoms, these tips may help relieve symptoms:
The scientific evidence indicates that no one form of estrogen or estrogen plus a progestin is more effective than any other. Taking effectiveness, safety, the choice for mode of delivery, and cost into account, the report chooses the following as Best Buy Drugs for the treatment of menopausal symptoms:
All of the Best Buys are as effective as other hormone drugs, but less expensive. In particular, the two estradiol pills could save you $300 to $450 a year out-of-pocket compared with brand-name Premarin. If you choose an estrogen hormone patch, generic estradiol could save you $200 to $400 a year over the higher-priced products.
Be aware: Hormone treatment can cause side effects. The most common are heavier or lighter vaginal bleeding, thickening of the uterine lining, nausea and vomiting, breast tenderness, headache, weight change, and dizziness. Heavier vaginal bleeding and breast tenderness tend to be the most bothersome. Between 20 percent and 25 percent of women stop taking hormones because of side effects. Lower doses can reduce your chance of experiencing them.
But if you have debilitating menopause symptoms (hot flashes, night sweats, disturbed sleep, and vaginal dryness), you may still want to consider hormone treatment. Low doses used for a short period are now common practice for women with severe symptoms and may be quite safe, although the research on that use is not yet conclusive.
A new report from Consumer Reports Best Buy Drugs, based on the latest scientific research, will help you talk to your doctor about whether you need hormone treatment, and if so, which drugs may be the best. The full report is available free at www.CRBestBuyDrugs.org or by clicking here.
The report makes the following overall recommendations:
- Don't take hormones if your symptoms are mild and manageable with lifestyle changes and adjustments. (See below).
- Don't take hormones if you have heart disease or have had a stroke or cancer of the breast, ovaries, or uterus. Also don't take hormones if you are at elevated risk of these conditions (for example, if you smoke, have elevated cholesterol, or diabetes).
- If you must take hormones because your symptoms are severe, take the lowest dose possible for the shortest duration possible. The risk associated with such use appears to be quite low, but definitive studies on that are not yet complete.
- Hormones should not be used to treat mood swings, irritability, depression, anxiety, mental lapses, forgetfulness, cognitive difficulties, reduced libido, urinary incontinence, back pain, chronic pain, joint pain, stiffness, or fatigue. Not only do hormones fail to help relieve these conditions, but they could also make them worse.
- Herbs, supplements, and "bioidentical" hormone products widely touted as alternatives to estrogen and progestin lack proof of effectiveness and safety and should be used with caution. Consult a physician about them.
Although the increased risk posed by hormones (of heart disease, breast cancer, stroke, blood clots, and dementia) is relatively small, the danger is that it could add to existing risk factors for tens of millions of women.
For example, a woman who has high blood pressure and diabetes is already at elevated risk for heart attack and stroke. Taking hormones adds to that risk. Similarly, a woman who has high cholesterol and a family history of early heart disease and breast cancer would add to existing elevated risk if she took hormones.
As for women who have mild symptoms, these tips may help relieve symptoms:
- Dress in layers, so you can remove clothes as needed
- Wear natural fabrics, such as cotton and silk
- Keep room temperatures cool or use a fan, especially at night
- Sleep with fewer blankets
- Drink cold beverages rather than hot ones
- Limit intake of caffeine and alcohol
- Eat smaller meals and avoid spicy food
- Get regular exercise
- Reduce stress
- Don't smoke
- Try relaxation techniques, meditation, or yoga
The scientific evidence indicates that no one form of estrogen or estrogen plus a progestin is more effective than any other. Taking effectiveness, safety, the choice for mode of delivery, and cost into account, the report chooses the following as Best Buy Drugs for the treatment of menopausal symptoms:
- Estratab or Menest pills (esterified estrogen)
- Generic estradiol pills
- Generic medroxyprogesterone pills (when a progestin alone is needed)
- Gynodiol pills (estradiol)
- Alora patch (estradiol)
- Generic estradiol patch
- Vivelle or Vivelle Dot patch (estradiol)
- Ogen Cream (estropipate)
- Premarin Cream (conjugated equine estrogen)
- Estring (estradiol, vaginal ring)
- FemRing (estradiol, vaginal ring)
All of the Best Buys are as effective as other hormone drugs, but less expensive. In particular, the two estradiol pills could save you $300 to $450 a year out-of-pocket compared with brand-name Premarin. If you choose an estrogen hormone patch, generic estradiol could save you $200 to $400 a year over the higher-priced products.
Be aware: Hormone treatment can cause side effects. The most common are heavier or lighter vaginal bleeding, thickening of the uterine lining, nausea and vomiting, breast tenderness, headache, weight change, and dizziness. Heavier vaginal bleeding and breast tenderness tend to be the most bothersome. Between 20 percent and 25 percent of women stop taking hormones because of side effects. Lower doses can reduce your chance of experiencing them.
Is menopause to blame?
| Main symptoms of menopause | Symptoms not clearly linked to menopause |
|
|
Risks and benefits of hormone therapy
| Condition or disease | Increased or decreased risk with estrogen plus progestin1 | Increased or decreased risk with estrogen alone1 |
| Blood clots (legs, lungs) | Increased | Increased |
| Breast cancer | Increased | Not certain2 |
| Colorectal cancer | Decreased3 | No difference2 |
| Dementia | Increased | Increased |
| Endometrial cancer | No difference2 | Increased |
| Heart disease and heart attack | Increased | Not certain2 |
| Osteoporosis or bone fractures | Decreased | Decreased |
| Stroke | Increased | Increased |
| Uterine cancer | No difference2 | Increased |
Source: Facts About Menopausal Hormone Therapy,
National Institutes of Health, Pub No 05-5200. Revised June 2005.
1. Based on Women's Health Initiative Study, 2002. Study enrolled only healthy women so risk may be greater if other risk factors are present.
2. "Not certain" means studies don't allow conclusive statement of risk; studies are ongoing. Some increased risk may exist. "No difference" means neither increased nor decreased risk was found.
3. Not statistically significant.
1. Based on Women's Health Initiative Study, 2002. Study enrolled only healthy women so risk may be greater if other risk factors are present.
2. "Not certain" means studies don't allow conclusive statement of risk; studies are ongoing. Some increased risk may exist. "No difference" means neither increased nor decreased risk was found.
3. Not statistically significant.
Consumer Reports Best Buy Drugs is a grant-funded
public information project administered by Consumers Union. This menopause
report is the latest in a series of reports on commonly used prescription
drugs. All are available free on the site.
This site is for your information only. For medical advice, consult a health professional.
