Alternatives to HRT

Abstract

<h2>Abstract</h2> Publicity after publication of the Women's Health Initiative and the Million Women Study has led to women stopping HRT. They may then be troubled with vasomotor symptoms or dyspareunia, and concerned about skeletal conservation. Use of standard pharmacopoeia and alternative and complementary therapies are discussed. Options for treating vasomotor symptoms include progestogens, selective serotonin re-uptake inhibitors and gabapentin. Clonidine and propranolol are ineffective. For the prevention and treatment of osteoporosis, the options are bisphosphonates, strontium ranelate, raloxifene and parathyroid hormone. It is important to note that most studies have been undertaken in elderly women with osteoporosis or at increased risk of the disease and the placebo group received calcium supplements. There is little information about the use of these agents in young women, particularly those with premature menopause. There is little scientific evidence that complementary and alternative therapies can help menopausal symptoms or provide the same benefits as conventional therapies, yet many women use them, believing them to be safer and ‘more natural'. The choice of treatments is confusing and, unlike conventional medicines, not much is known about their active ingredients, safety and side-effects, or how they may interact with other therapies. They can interfere with warfarin, antidepressants and anti-epilpetics, with potentially fatal consequences. Some herbal preparations may contain estrogenic compounds, and this is a concern for women with hormone-dependent disease such as breast cancer. There is also concern about contaminants such as mercury, arsenic, lead and pesticides.