Several anti-hypertensive drugs can relieve menopausal hot flashes. But they have severe
side effects such as, fatigue and dizziness. If you have severe flashes but no other
recourse for treatment, or if you have hot flashes as well as high blood pressure,
generics such as clonidine might be appropriate for you. It is thought that these drugs
work by exerting a stabilizing effect on the hypothalamus, the body's thermostat.
Clonidine is shown to alleviate flushing by 30 to 40 percent. It comes in pill form or
as skin patches. The normal dose is 0.1 and 0.2 mg twice daily. A physician may begin
treatment with a lesser dose (0.05 mg twice daily), hoping to both quell hot flashes and
keep side effects at bay.
Inderal, aldomet, and veralipride also are used for menopausal hot flash reduction, as
are beta-blockers such as sotalol. None of the above-mentioned drugs has FDA approval for
this treatment use.
Bellergal, the brand name for a mixture of phenobarbital, belladonna, and ergotamine
tartrate, has been shown to reduce hot flashes by 50 percent and has FDA approval for the
treatment of menopausal hot flashes. Unfortunately, its barbiturate components can cause
addiction. Side effects include dry mouth, fatigue, and depression. Because of its
addictive properties, Bellergal isn't usually recommended for hot flashes, and if used
should be restricted to the short term.
Vaginal Dryness, Painful Intercourse,
And Painful Urination
Non-hormonal Vaginal Moisturizers
Several over-the-counter vaginal lubricants can help women overcome vaginal dryness,
painful intercourse, and painful urination due to estrogen depletion. Make sure that the
moisturizer you choose is water soluble, since those that aren't (petroleum jelly, for in-
stance) create a moisture barrier that works against lubrication. Certain of these
products are used only at the time of intercourse, while others are designed for more
continuous relief of vaginal dryness.
Non-hormonal creams can relieve vaginal dryness more rapidly than estrogen creams. But
since they contain no estrogens, they won't stimulate a cellular buildup of vaginal tissue
over time. Therefore, for a continuous reduction of vaginal dryness, you'll need to keep
reusing the recommended dosage continuously. In comparison, estrogen cream doses can often
be reduced as vaginal dryness abates. Vaginal lubricants aren't as effective as vaginal
estrogens in controlling urinary tract infections. Yet they can help maintain a pH level
that thwarts infection.
Most over-the-counter vaginal moisturizers work short- term, at the time of use.
Polycarbophil, the active ingredient in the product Reptens, represents a novel effort
toward continuous treatment of vaginal dryness. Its bio- adhesive delivery system draws
water out of cells into the vaginal area. Hence the body's own fluids lend to continuous
lubrication. Unfortunately, Replens is very expensive. It's usually used three times a
week. Other effective over-the-counter moisturizers include Astroglide (a gel) and Lubrin
Functional Electrical Stimulation
This approach uses a vaginal probe to deliver short bursts of electrical current
through the vaginal wall to pelvic muscles, causing pelvic muscles to contract and, over
time, strengthen. Some reports state that electrical stimulation can significantly reduce
incontinence, although the full benefits of this technique need further review. The
procedure is usually performed on a daily basis for several weeks.
Recently approved by the FDA for specific causes of stress urinary incontinence, this
procedure involves the use of collagen, a protein found in humans and animals. When
collagen is injected into tissue around the urethra, it can build up tissue bulk. This
provides more pressure around the urethra so that if intra-abdominal pressure increases
because of a cough or sneeze, it will be counteracted by the collagen, and thus urine will
not leak out. This technique reportedly has a 50 to 75 percent success rate.
Medications and Surgery for Incontinence
No safe and effective drugs are available for relief from stress incontinence. A few
medications can improve urge incontinence for certain women. The antidepressant
imipramine, for example, relaxes the bladder, which can serve to make the pressure of the
urethra greater than the pressure in the bladder, preventing leakage. Imipramine's side
effects (dry mouth, dizziness), however, may limit its use. Ditropan (brand name), an
antispasmodic, is also used to treat incontinence, although users may experience diarrhea,
drowsiness, blurred vision and other side effects.
If stress incontinence is severe, many different types of surgery can be attempted. The
general goal is to restore the structural relationship between the urethra, urthrovesical
junction, bladder, and other pelvic organs. However, surgery can also create new
bladder-related disorders, including urge incontinence and voiding problems. If surgery is
undertaken, the drawbacks that might arise may still seem more manageable than what a
woman was experiencing beforehand.
For Bone Loss
Some of the treatments included here use hormones derived from the thyroid and
parathyroid glands. These hormones aren't considered "hormone replacement"
therapies since they aren't replacing ovarian- made hormones. Their use does not appear to
create the cancer-related risks cited for erogenous estrogens.
Replacement estrogens and calcitonin are the only medications approved by the FDA for
the treatment of bone loss. Other therapies (including those described here) should be
A hormone made by the thyroid gland, calcitonin is known to inhibit bone
the process by which bone is broken down and reabsorbed in the body. There's indication
that it also regulates calcium metabolism. When used as a treatment, calcitonin has been
shown to slow bone loss and may improve bone density. However, it does not decrease
fractures in post- menopausal women the way replacement estrogens have been shown to do.
This treatment may be most beneficial to those who have a high bone turnover with rapid
Form: Injection, Nasal spray
Side Effects: Less than 10% experience flushing, nausea, and dizziness. These can be
minimized by taking the drug at bedtime.
Nasal spray is sprayed in one nostril one day and the other nostril the other
The bisphosphonates are synthetic compounds made out of phosphorous and carbon. When
incorporated into bone, they inhibit bone resorption and may reduce the vertebral fracture
rate. While these compounds can work as a successful short-term therapy for postmenopausal
bone loss, their longer-term effects on osteoporosis aren't yet known.
The bisphosphonate most in use for treating bone disorders is etidronate (generic
name), a drug which has federal approval for the treatment of Paget's disease and high
levels of calcium in the blood due to cancer (hypercalcemia).
Initial studies suggest that an effective regimen consists of taking etidronate daily
(400 mg) for two weeks every three months, with calcium (1,000 to 1,500 mg) taken daily
when the drug isn't being taken.
Poorly absorbed. Take in an empty stomach.
Side Effects: No significant side effects were observed when treating bone
Less expensive than calcitonin.
A new drug called Fosamax (alendrinate) shows promise in treating women who already
have osteoporosis. In a five-year study, women with low bone density were able to increase
their bone density with daily doses of Fosamax..
Poorly absorbed from the intestines, take on an empty stomach, first thing in the
morning with a glass of water and then wait a half hour before eating anything.
Side Effects: esophageal ulceration, so don't lie down directly after taking the
This treatment carries the unique potential of activating new bone growth, according to
researchers, unlike other available treatments, which mostly retard bone loss. Parathyroid
hormone is produced in four small glands located behind the thyroid gland. When low doses
of parathyroid hormone are administered intermittently by once-a-day injections, the
result is the stimulation of bone-forming cells (osteoblasts) and an increase in bone
mass. In human studies, this approach has consistently resulted in significant increases
in trabecular bone (the spongy, inner part of bone) of the spine. Few changes in cortical
bone (the outer, more dense part of bone) have been observed.