Edition: U.S. / Global

Personal Health

By Jane E. Brody
Published: May 20, 1992

DESPITE renewed interest in estrogens to treat the sometimes distressing symptoms of menopause and its long-term effects on the health of the heart and bones, fewer than one woman in five who has reached that stage of life now uses hormone replacement therapy. For those who do not, many other options are available to help limit the immediate and distant health effects of the menopausal decline in estrogen.

Hormone replacement is clearly not for every menopausal woman. Some have medical conditions or family medical histories that make hormone therapy inadvisable. Some fear the suspected long-term risks, like breast cancer, and others react adversely to the treatment. Even among those who start hormone therapy, only about one-third use it regularly, and many abandon the treatments after the most common immediate symptoms of menopause, hot flashes, subside.

Also, many women are simply opposed to the idea of taking any kind of medication day after day, year after year, when they feel perfectly fine. Among those who are seriously bothered by hot flashes, vaginal dryness or other menopausal symptoms, many seek alternatives to hormones. Relieving Symptoms

Many nonhormonal drugs and nondrug approaches have been tried with varying degrees of success. In a coming report on the treatment of menopause, the Congressional Office of Technology Assessment states that only one nonhormonal drug, Bellergal, has been officially approved for use in treating hot flashes, sweating, restlessness and insomnia associated with menopause. And the agency said the drug, which mainly contains the sedative phenobarbital, helped only half the women who took it and was potentially addictive.

As for "natural remedies" like vitamins and herbs, and approaches like diet, exercise and biofeedback, only limited research has been done and most of the claims for effectiveness are not based on scientifically designed studies. Still, there are many anecdotal reports and several clinical studies that indicate they are helpful to some women.

Among the most popular approaches to relieving menopausal symptoms are these:

*Vitamin E, in daily doses of about 400 to 800 International Units, has been said to reduce the frequency and severity of hot flashes and enhance energy and a sense of well-being in many women who have tried it. The vitamin, taken for a long time, has also been associated with relief of vaginal dryness and related symptoms. Vitamin E may have other benefits to the postmenopausal woman. It is a potent antioxidant that could reduce her risk of developing heart disease and cancer and is generally considered safe in these amounts.

*Vitamin B6, which may become depleted when a woman's estrogen production wanes, has not been scientifically established as effective for menopausal symptoms. Still, varying reports say that doses of 50 to 200 milligrams of B6 (pyroxidine) can alleviate the depression, emotional instability, fatigue, loss of libido and disruptions in concentration that some women experience as they pass through menopause. But megadoses of B6 can also cause serious neurological problems, and daily doses of 200 milligrams or more generally are not recommended.

*Ginseng, a popular herbal remedy that contains hormone-like compounds that mimic estrogen, is widely acclaimed as a menopausal remedy. It can be consumed in capsule form, root form or as a tea, powder or syrup. However, it has not been tested for effectiveness in scientifically designed studies. According to Dr. Claude L. Hughes, a gynecologist affiliated with the Duke University Medical Center, other foods that contain varying amounts of plant estrogens include alfalfa, anise, apples, barley, carrots, cherries, clover, coffee, fennel, garlic, green beans, hops, licorice, oats, parsley, peas, promegranates, potatoes, red beans, rice, rye, sage, sesame seeds, soybeans and sprouts, wheat and yeast.

*Clonidine, a drug used to treat high blood pressure, has been shown in some well-designed and highly publicized studies to reduce the frequency and severity of hot flashes by as much as 40 percent. Its possible side effects include dizziness, dry mouth, fatigue, irritability and nausea. A less well-known alternative, Veralipride, has been 60 to 80 percent effective in reducing hot flashes in a number of studies. Various other drugs have shown limited effectiveness in small studies. However, none of these treatments is effective for other menopausal symptoms like vaginal dryness, anxiety and sleeplessness. Nor do they prevent bone loss, a major benefit of estrogen replacement.

*Biofeedback, which can help people regulate their body temperature, has been promoted as helpful in treating hot flashes, but this technique of training people to control automatic body responses has not been put to a definitive test for this purpose.

*Regular sexual activity can help to maintain vaginal tissues and lubrication. As an alternative, some doctors recommend use of a dildo. Many women find it helpful to use a lubricant, like K-Y Jelly or products specifically marketed for vaginal lubrication. Curbing Serious Risks