Ah being a woman of a *certain* age. Estrogen seems to be a wonder drug, but one with potential issues (ie ? breast cancer, clot risk). The WHI study scared the world into doing no hormone replacement. So what can we do?
Again, I am writing this as I did a deep dive into the menopause matter as I too am a woman in this age group, and as a plastic surgeon I see the ravages of perimenopause and menopause changes in hair, skin, and skin tone. This is not to replace seeing a doctor and getting true advice. I actually became part of a telehealth group dedicated JUST to advise women 40 and older on all of the symptoms of menopause. (It is covered by insurance, each plan is individualized, and you can reach it HERE)
So what are the options?
- Antidepressants. Some studies show reduction in hot flashes and insomnia. Larger studies show conflicting data. FDA rejected approval of listing it as treatment for hot flashes.
- Antiseizure medications (gabapentin, neurontin). “off label” can be used for hot flashes. Does not reduce symptoms as much as estrogen does. May have side effects (dizzy, nausea, diarrhea, constipation, dry mouth).
- Botanicals/Herbals. Omegas, Clover Extract, Chinese herbs, Evening Primrose Oil, Ginseng, Black Cohosh. A metanalysis in JAMA of nonhormonal therapies found a modest reduction in hot flashes and vaginal dryness but no improvement in night sweats, and recommended better studies, as most studies were poor quality. STUDY HERE
- Bioidenticals. This is a marketing term. They are prescription, usually estradiol. Regulated by FDA. So this is doing hormone replacement. It is not “more natural” or “better.”
- Compounded hormones. Made by local pharmacies. NOT regulated by the FDA. Most doctors (even the ones who are pro-HRT) do not recommend these, as there is difficult quality control, so you don’t know exactly how much you are getting. Again, it is real hormones, just less predictable dosage given.
My thoughts?
If you have a true contraindication to hormone replacement or really don’t want to do hormones, (and I have to say, the studies are muddied), these are other options for you. In general, if you go through the risk assessment and your symptoms and decide to do hormone replacement, you want it to be FDA regulated medical grade. It is important to know what and how much you are getting.