Of course there are also women who wish to refrain from taking HRTs or supplementing their hormones (these may not be considered the same thing by some women). We've read comments from many women who are afraid of hormones or HRTs because of some family history of cancer or because they had their hysts for cancer. But not all cancers are the same in the effects hormones may have on them, and if you don't know, for sure and in detail, that your specific cancer or family risk is specifically estrogen-mediated, you may want to discuss your own particular risk factors with an oncologist. Just because cousin Mabel thinks she recalls that Great-aunt Violet died of some sort of cancer doesn't mean that HRT may pose an unacceptable level of risk for you.
By the same token, if you cannot safely take HRTs, please understand that alternative HRTs like nutraceuticals and high-phytoestrogen foods do contain functional hormones and carry those same risks you're avoiding with prescription HRTs. And consider further that if you deem a family or personal cancer risk too high to supplement your hormones, you may want to discuss with an oncologist whether your own hormones also present that level of risk. Remember: your body doesn't stop producing hormones entirely when you lose your ovaries: you are still producing enough for the majority of your needs via body fat and adrenal conversion. If the small increment that HRT use adds is too dangerous, so too might your own production pose an unacceptable risk. An oncologist can help you explore whether you need to take drugs to block all hormone production or use in the body, and this may be every bit as important for you as not adding more to your system.
We also hear from many women who don't want to take "artificial medicines" that "make menopause a disease." Well, neither do we. Alas but HRT has been demonized plenty, both in the popular media and by crusaders who view it as nothing more than an evil plot by doctors/pharmaceutical companies/aliens to enslave women. That ignores, sadly, the real situation of surgical menopause as characterised by a shortage of something normal to the body's functioning and replaceable with equivalent chemically-structured supplements. We're not proselytizing for the use of HRT, but we are, strongly, urging women to research and understand the physiology behind their hormone needs and how they can be met. It's not a case where taking HRT is the only side of the question that has potentially negative impacts on health: not taking it can be just as devastating, can raise mortality risks just as high. And sadder yet are those who try to meet their hormone needs with alternative HRTs all the while denying that they are taking HRT and failing to monitor for those hormone risks. Whatever you do, please understand both the risks and benefits; don't just be swayed by fearmongers and salesmen.
For those, then, who cannot or choose not to supplement their hormones beyond what their own body can produce, there are a number of coping strategies that may be of use in dealing, one by one, with the aspects of hormonal deficiency that most plague you. The big question for women in this situation is well, what can I do? We'll do a rundown here of the most common problems.
In addition to that, we need to provide our bone-building cells with the raw materials to construct those bones. This means about 1200-1500 mg calcium and 600-750 mg of magnesium, 15-30mg of zinc, and 800 mg of folic acid. We also need to make sure our vitamin D intake is adequate; while the US government standard has been raised from 400 IU daily to 600- 800 IU, the latest numbers we're seeing call for 1000 IU daily (free signup required to read) and many physicians, especially in higher latitudes, are recommending 2000 IU to their patients. It is widely believed that caffeine is a bone-robbing culprit, but that has recently been demonstrated not to be the case (it does boost circulating estrone, an estrogen, and for that reason is not something to binge on if you can't use HRT).
Bone scans are even more important for those who cannot use HRT, and getting a baseline density measurement soon after your hyst may be wise to track changes. There are a number of different drugs doctors can prescribe if we develop osteoporosis, but each of them carries fairly significant and not necessarily reversible risks of their own, and they are all rather expensive for lifelong maintenance.
Dry skin, eyes and hair
Soy, while considered by many naturally-menopaused women to be useful for hot flashes and other estrogenic effects, is shown to be too estrogenic in the biochemistry of its action to be safe for those avoiding estrogen. Soy isoflavones have not been demonstrated as effective as whole soy, although combination products of the two may be a little more potent (or may not).
The other potentially-useful agent is an SSRI (selective serotonin reuptake inhibitor) antidepressant. Because these drugs boost serotonin, which can occupy estrogen receptors in the brain, SSRIs can be very effective in combating both the hot flashes and the depression that can result from lack of estrogen. They are not totally benign drugs and must be used under a doctor's supervision, but they can be true lifesavers. An older drug that was used to treat hot flashes, bellergal, is a less-attractive choice because of its sedative and drying properties. Clonidine, a blood pressure drug, and Gabapentin, an anti-seizure drug, are other non-hormonal drugs used to treat flashes but also have significant side effects. All of these agents may decrease the frequency and intensity of flashes but probably will not eliminate them entirely.
Depression, mood swings, crying, lethargy
Stepping up in intervention is use of an antidepressant. St. John's Wort continues to be well-regarded by some practitioners as a safe and effective antidepressant. For some women, it's all they need; for others, it's not just strong enough. In those cases, treatment with an SSRI antidepressant would seem to us to be a desirable approach. Some of us who cannot use hormones are now using an SSRI, and the rest of us would like you to know, it's making a vast difference that both they and we can see. An article published by CNN in Dec. 2000 cited a Mayo Clinic researcher, Dr. Charles Loprinzi, who reported that "a four-week trial involving 229 women, most of whom had a history of breast cancer, revealed that venlafaxine was 60 percent effective against hot flashes. The optimum dosage was 75 milligrams daily," Loprinzi said. "And the effects we saw were within a week." The report is the end result of ten years of studies looking for the best solution for breast cancer patients, and finds that venlafaxine (Effexor) to be expensive, but far more effective than any other of the traditional medical, herbal or vitamin remedies. This has been further supported by research since then, and an SSRI is now considered a standard of treatment. As with hormones, different women respond differently to each SSRI, so some experimentation may be necessary to find the best, most effective one for any given woman.
Depression in menopause is both over-dramatized and under-appreciated. Women tend to blame themselves (and doctors may help them do it) for not "getting a grip" and "having a positive attitude." Sure, it's a rough adjustment, especially when we're limited in our choices and the transition is traumatic. But there are also real, physiological issues here. For the best explanation we've seen, we highly recommend the book Women's Moods by Deborah Sichel and Jeanne Watson Driscoll for a scientifically-sound but not incomprehensible discussion of the topic, including a number of self-help steps any woman can take to help cushion her brain from the effects of menopause. The link in the book title above takes you to a more in-depth report on this book here, but you can also check your favorite used book store or library for a copy.