Menopause Without Estrogen

"Natural" means work

What do you do if you've decided that you can't-or won't-take replacement hormones after menopause? If you've chosen a totally natural menopause, now you really have to get to work. Even with no apparent risk factors, one in two American women is at risk of breaking a bone after menopause, due to osteoporosis. And one in three women after the age of 65 develops coronary heart disease.

Protecting your bones

Building and preserving bone strength is important for all women of perimenopausal age, regardless of their decision about hormone replacement therapy. To help prevent osteoporosis:

• Take calcium-1,500 mg total (diet plus supplements) daily, with meals for better absorption and take between 400 and 800 I.U. of Vitamin D a day. Vitamin D is essential for calcium absorption, and as we get older our bodies are less able to absorb Vitamin D from sunlight.
• When choosing a calcium supplement, read the labels carefully. The most important piece of information to look for is the amount of elemental calcium (the kind your body needs) contained in the supplement. Some formulations of calcium contain less elemental calcium than others, for example:
  

  Type	% elemental
  calcium carbonate	40
  calcium citrate	21
  calcium lactate	13
  calcium gluconate	9

• Calcium citrate is more easily absorbed in older women. Our digestive tracts secrete less acid as we age, making it harder for our bodies to absorb other forms of calcium. Calcium citrate is more expensive than other forms.
• Exercise regularly, with weightbearing exercise (brisk walking, jogging, bicycling, weight lifting with small weights or rubber bands) that exerts intermittent pressure on your bones. Swimming is not a weightbearing exercise.
• Cut down the amount of protein in your diet-eating too much protein leaches calcium from your bones.
• Avoid drinking alcohol, caffeine, and carbonated sodas (which contain high levels of phosphates)all of these increase bone loss.
• Eat plenty of whole grains, fruits, and vegetables, especially leafy green vegetables, and consider taking a nutritional supplement like ProCycle^® Gold for trace minerals and nutrients.
• Increase the amount of soy protein in your diet by adding soybeans, soy nuts, soy milk, tofu or other soy products to your meals and snacks. Soy contains phytoestrogens called isoflavones. The amount of isoflavones in soy foods varies 50 mg of isoflavones per day is a good target amount.

Bone-strengthening medications

Medications to prevent or slow osteoporosis include calcitonin, an "antiresorptive" agent approved for osteoporosis treatment by the FDA. Available as a nasal spray and also given by injection, calcitonin stops the loss of bone. Side effects may include nausea, flushing, or a skin rash.

Fosamax is a nonhormonal drug used to increase bone density in postmenopausal women. The drug has not yet been studied for longer than three years; its long-term effects are not yet known.

Etidronate, a bisphosphonate that is FDA-approved for treatment of another bone disease (Paget's disease), has fewer short-term side effects than calcitonin and can be taken for short periods to stop bone loss. If etidronate is taken for too long, however, it can actually inhibit bone formation and increase the risk of fractures.

The drug ipriflavone, a soy derivative, also shows promise in treating and perhaps preventing osteoporosis. It is not yet approved in the U.S. for osteoporosis treatment, however, although it is used in Italy and Japan.

To help prevent heart disease:

• Again, exercise regularly, with steady aerobic exercise: walking, jogging, bicycling.
• Eat a very low-fat diet-no more than 2 grams of fat per 100 calories-and avoid saturated fats.
• Omega 3 fatty acids may have a role in preventing heart disease. Fish is a good source of omega 3 fatty acids (mackerel, herring, tuna, sardines, salmon, shellfish).
• Meditate or perform other stress reduction exercises every day. Stress plays a significant role in the development of heart disease.
• Keep your blood pressure, choles-terol, and trig lycerides at healthy levels and monitor them regularly.
• Take 100-400 I.U. of Vitamin E daily; the Harvard Nurses' Health Study showed this may reduce heart attack risk by at least 40 percent.

Reducing symptoms without estrogen

Vitamin E and a low-fat diet high in vegetables may have the added benefit of reducing hot flashes. In clinical trials, Remifemin, which is black cohosh, has also been found to reduce hot flashes. Remifemin has been used in Europe since the 1950s. The black cohosh plant has estrogenic effects and may minimize hot flashes by decreasing the body's supply of luteinizing hormone (LH). Some doctors prescribe black cohosh; it is also available in health food stores and from Women's Health America.

Vitamin E oil or creams can be substituted for estrogen creams in treating vaginal dryness; over-the-counter lubricants (such as Astroglide) or moisturizers (Replens, for example) are also available

Medical alternatives

If you want to take estrogen but can't, some medical alternatives do exist. While not as effective as estrogen, progestins (medroxyprogesterone acetates, like Provera, Amen, and Cycrin) can reduce menopause symptoms significantly. Tamoxifen-nonsteroidal, antiestrogen agent taken by women being treated for breast cancer-can also help reduce a woman's risk of heart disease by half. Tamoxifen may also reduce spinal bone loss, but the FDA has not approved it for use against osteoporosis. Tamoxifen is not without risk; it is associated with an increased incidence of uterine cancer.

Also under investigation is a group of drugs called SERMS (selective estrogen receptor modulators, also called "designer estrogens"). These drugs are believed to provide estrogen's protective effects on the heart and bones, but without risk of uterine cancer. SERMS may also prove to have some benefit in preventing breast cancer, but there is not yet enough clinical evidence to make this claim.