Health & Fitness

Beyond HRT — phytoestrogens, antidepressants may help some menopausal women

Hollywood resident Donna Silver describes her night sweats this way: “You want to get up in the middle of the night and stand in a freezer.”

The night sweats started at about 51 — the age doctors say menopause typically begins. They got so bad she would soak through her pajamas.

Then at about 58, Silver started experiencing hot flashes. She started taking a fan everywhere, and got a special air-conditioning unit installed in her bedroom. Now 59, Silver says she’s gaining weight and rarely gets a good night’s sleep.

Silver, a marketing specialist, is battling menopause. At about age 51 or 52, the body stops producing hormones like estrogen and progesterone and menstruation becomes irregular before finally stopping. When that happens, the majority of women experience such symptoms as hot flashes, night sweats, weight gain and vaginal thinning and dryness, which can lead to painful intercourse.

Additionally, menopause has been linked to bone density loss, high blood pressure and heart disease.

In the 1930s, hormone replacement therapy — medications containing either horse or synthetic female hormones — was first developed and later became the standard treatment for women suffering through menopausal symptoms. HRT skyrocketed to popularity in the 1960s thanks to an advertising campaign by pharmaceutical companies touting it as a magical elixir that would keep women — and their skin and bones — youthful. It was also thought to help prevent memory loss.

However, concern arose in the 1950s over increasing rates of uterine cancer seen in women using equine estrogen. That led to companies changing the composition of the HRT to synthetic.

Still, concerns reemerged in the 1990s after clinical trials demonstrated a link between HRT and blood clots, stroke and breast cancer.

The largest study was the Women’s Health Initiative (WHI), a 15-year study tracking more than 161,800 healthy, post-menopausal women. Under the study, launched in 1991, some women took estrogen alone, some took estrogen plus progestin and some took a placebo.

The study found that women who took the combination therapy had an increased risk of heart disease. Additionally, researchers estimate that due to the decrease in HRT following the WHI findings, there have been 15,000 to 20,000 fewer breast cancer cases in the United States.

In the wake of new research and a closer examination of the WHI study, doctors are now again prescribing HRT in various forms for certain post-menopausal women — namely, those whose symptoms are severe and are in the early stages of menopause. They also recommend estrogen therapy alone only when the woman has had a hysterectomy.

Antidepressant study

Additionally, other treatments have become available. A recent study by the Fred Hutchinson Cancer Research Center showed that low doses of antidepressants offer benefits similar to estrogen without the risks.

A recent National Institutes of Health-funded study compared both low-dose estrogen and Effexor XR (venlafaxine), an antidepressant, with a placebo for the relief of hot flashes. The study was the first of its kind to pit estrogen directly against an antidepressant.

According to the data, low-dose estrogen reduced hot flashes by 53 percent while Effexor XR reduced them by 48 percent. The placebo reduced hot flashes by 29 percent

The widespread popularity of a book by television personality Suzanne Somers touting the use of bioidentical hormone replacement therapy was a game-changer. Women flooded their doctors’ offices asking about the new-age treatment.

Bioidenticals are a natural hormone replacement therapy that Somers and others claim achieves the same goals as HRT but naturally, and without the health risks. However, doctors and medical groups say there are no studies proving the results touted by Somers. Plus, since bioidenticals must be mixed by compounding pharmacies, there are no labels warning of side effects or potential harm, as the Food and Drug Administration requires with pharmaceuticals.


In keeping with the desire for natural treatments, women are turning to phytoestrogens. Phytoestrogens are chemicals found naturally in plants and foods such as whole grains, leafy greens, beans and garlic that may mimic estrogen.

However, a 2001 research study into phytoestrogens’ role in replacing estrogen and fighting osteoporosis and cardiovascular disease was disappointing. The review, published in the Archives of Internal Medicine, analyzed 74 studies on phytoestrogens, concluding there isn’t enough evidence to recommend them in place of traditional HRT.

Dr. Arthur Shapiro, a reproductive endocrinology and infertility specialist at the University of Miami, still prescribes HRT to patients who are experiencing moderate to serious menopausal symptoms and are “five to 10 years” into menopause.

“The symptoms are not 100 percent curable, but they get virtually total relief,” said Shapiro, a professor at the University of Miami Miller School of Medicine. “A lot of it is about quality of life.”

These days, Shapiro tends to use estrogen replacement therapy that is administered through a patch, gel or spray rather than orally. And, like the majority of traditional physicians, he calls bioidenticals “misleading.”

“The problem is they’re compounded by a local pharmacist and not overseen by pharmaceutical companies,” he said.

Shapiro also called over-the-counter medicines containing soy products, flaxseed or primrose oil that are touted to help with menopause “a placebo.”

Heart, circulatory effects

Meanwhile, there is the issue of menopause and its impact on women’s hearts and circulatory systems.

Studies have shown a definitive increase in heart attacks and strokes eight to 10 years after menopause, notes Dr. Veronica McCloskey, a cardiologist at Mount Sinai Medical Center in Miami Beach.

“We know that estrogen protects the heart, and that the blood vessels appear to be more flexible before menopause,” she said. “And after menopause, cholesterol levels go up and we see the incidence of high blood pressure and diabetes go up.”

Unfortunately, HRT does not stop these circulatory changes from occurring, she said.

However, women can fight this trend by watching their weight, stopping smoking, changing their diet, exercising and treating high cholesterol and high blood pressure with medication, she noted.

“The most important thing is for women to know their risk factors so they can modify them,” McCloskey said.