Treatment Options

Self Help/Lifestyle Measures

Vasomotor Symptoms
These are often joked about, eg. "I’m having a tropical moment", "I’m still hot", "they just come in flushes now", however, these can be particularly troublesome. We are aware that flushes can be triggered by certain events, such as consuming caffeine, alcohol, spicy foods, stress and smoking, and measures can be taken to reduce the intensity & frequency of them.

Limit caffeine and alcohol, avoid spicy foods, reduce stress/practice relaxation techniques, stop smoking, drink cool fluids, wear layers of thin clothing of natural not man-made fibres, which can be removed and put back on as needed, where possible sit near open window or use a hand held fan.

Exercise
Taking regular exercise is good for bone, heart and general health and wellbeing. This can be weight bearing exercise (anything that you do on your legs – eg walking) or aerobic exercise (anything that gets your heart racing).

Diet
Control weight through regular exercise and sensible eating.
Avoid saturated fats and take 5 portions of fruit & veg per day as part of a well balanced diet. We need to ensure a sufficient intake of calcium for bone health. Calcium is found in a variety of foods - dairy products, dark green vegetables and small bony fish. Also take foods rich in phytoestrogens, oily fish or sources of omega-3 fatty acids twice per week.

Alcohol & Smoking
Smoking is the biggest cause of heart disease and increases the risk of cancer, stroke and thinning of the bones. It can be difficult to stop but there are a number of methods to get help: ask your GP or pharmacist for further information.
Research shows that the risk of heart disease can be reduced by a regular intake of a small quantity of alcohol (1-2 units per day) especially red wine.

Relaxation and Stress Relief
Excess stress has been linked to an increase in the risk of heart disease

Health Checks
Since the risk of certain illnesses increases with age and the onset of menopause, it is therefore important to have regular health checks, such as cervical smears, mammograms and blood pressure monitoring.

Conventional Medicine
A specialist will make the diagnosis from a description of your symptoms. In some cases no tests are required to make the diagnosis. If there is doubt about the diagnosis, FSH levels may be measured on one or more occasion. If other causes of symptoms, such as thyoid disease, are suspected blood, relevant blood tests will be arranged. If there is an increase in the risk of osteoporosis, a bone density scan will be organised.

Treatment of Hot Flushes
Prescription treatments for hot flashes include clonidine, a medication that also lowers blood pressure. Studies are also underway using certain antidepressants (known as SSRIs) to determine if they reduce hot flashes.

Hormone Replacement Therapy (HRT)
HRT usually comprises both an oestrogen and a progestogen. Giving oestrogen alone can increase the risk of cancer of the endometrium (lining of the womb). Progestogens are given at the same time to counteract this effect. Progestogens are usually given in a cyclical fashion at first, to give a regular withdrawl bleed, but later can be given continuously in a no-bleed regime. Oestrogen can be taken alone safely in women who have had a hysterectomy. Progesterone can also be taken alone, as studies have shown that it can improve hot flushes and night sweats.

HRT is available in a large range of preparations. Oestorgen can be given as tablets, patches, gels, implants, vaginal rings and nasal sprays. The progesterone component can be given in the form of a tablet or patch. If there is heavy or erratic bleeding on treatment, the levonorgestrel impregnated intra-uterine system (Mirena IUS) may be a useful way of administering the progesterone component.

Controversies about Hormone Replacement Therapy
There has been a lot of controversy recently about the role of oestrogen-based hormone replacement therapy (HRT) in the media after the publication of two large studies. These were a randomized trial called the Women’s Health Initiative (WHI) and an observational study called the Million Women study. As a result of this many women have been left confused and even frightened about what treatments are safe or appropriate. The UK British Menopause Society has produced a consensus statement by leading UK specialists.

They suggest that HRT does still offer potential benefit to outweigh harm, in symptomatic women, women with premature menopause and women at increased risk of osteoporosis providing the appropriate regime is used. The advise in given here is based on this assessment of the latest research. More information can be found on their website www.the-bms.org. An ISIS specialist can also discuss this with you in more detail. It may be useful to perform a bone density scan to make an assessment of your risk of osteoporosis to help you reach a decision.

Most women who request HRT do so for the relief of symptoms. Short-term use for symptoms is usually for around only 5 years. This is both effective and safe. The merits of long-term treatment need to be assessed for each individual woman, at regular annual intervals.

There is good evidence from randomised controlled trials that HRT reduces the risk of both spine and hip fractures, as well as other osteoporotic fractures. The most recent studies suggest that, for HRT to be an effective method of preventing fractures, continuous lifelong use is required. Regulatory authorities in the UK in 2003, advised that HRT should not be used as a first-line therapy for the prevention of osteoporosis, as the risks outweigh the benefits. This may be true for a population at no increased risk of osteoporosis, as in those women in the WHI study, but the risk-benefit ratio changes favourably when women are at increased risk of osteoporosis. Also while there are alternatives to HRT available, for the prevention and treatment of osteoporosis, oestrogen may still remain the best option for younger and/or symptomatic women. In addition few data are available on the effectiveness of the alternatives such as biphosphonates in perimenopausal and early postmenopausal women.

Women with a premature menopause should take HRT until the average age of the menopause (52 years) to reduce the risk of osteoporosis. In this group of women HRT is the most effective treatment to prevent osteoporosis. There is no risk in this treatment as the HRT is replacing oestrogen, which would have been present if the early menopause had not occurred. There is a significant risk of osteoporosis in women with premature menopause who do not take any form of treatment.

Tibolone
Tibilone is a synthetic steroid with oestrogen- like and androgen-like properties. It is effective in treating menopausal symptoms. It also conserves bone mass but data on its effects on reducing fractures are awaited. It also shares some of the same risks of oestrogen- based HRT.

Other treatments for bone loss
Several non-HRT medications may be used for preventing and treating osteoporosis.
The bisphosphonates, which include alendronate, etidronate and risedronate, have been shown in clinical trials to be effective in reducing bone loss in postmenopausal women and to reduce fracture risk in women who have osteoporosis. They can cause side effect of gastric disturbance and abdominal cramps.

Calcitonin (Miacalcic or Calsynar) is involved with parathyroid hormone in the regulation of bone turnover. It is given as a nasal spray or injections and has been found to reduce the risk of back fractures in women who have osteoporosis. It is useful in women for whom HRT or biphosphonates are unsuitable.

Raloxifene (Evista), a selective estrogen receptor modulator (SERM), is another therapy for osteoporosis. It reduces bone loss and appears to reduce the risk of back fractures in women with osteoporosis.

Another prevention drug currently under investigation is the drug PTH (parathyroid hormone).