Hormone replacement therapy (HRT) means any combination of the hormones estrogen and progestin. When HRT was first introduced to women decades ago, it was assumed the benefits outweighed the risks. Recent studies have proved those assumptions false in most cases. Prempro Dangers

Women should avoid using combined estrogen-progestin therapy if at all possible. Unless they are suffering severe menopausal symptoms that have not responded to any other form of treatment, women should first try non-synthetic, natural alternative therapies – including exercise and relaxation techniques.

Concern: Hot flashes and night sweats.
Alternative: Estrogen helps, but the estrogen in PremPro and Premarin are derived from the urine of pregnant mares. Drugs such as Tri-est or Estrace are considered “bio-identical” to those, but contain estrogens synthesized from plants. Other proven treatments for hot flashes include low doses of the antidepressants Effexor (venlafaxine), Prozac (fluoxetine), and Paxil (paroxetine). Some women experience a reduction in hot flashes when taking Vitamin E, others say soy relieves their symptoms, but research results are inconclusive and contradictory. A study published in the journal Obstetrics and Gynecology in 1999 found that natural progesterone cream significantly reduced hot flashes. The cream can be obtained over the counter or by prescription, depending on the amount of progesterone per ounce. As for herbs, the most common herbal remedy for hot flashes is black cohosh. However, the results of trials have been mixed.

Concern: Osteoporosis or broken bones.
Alternative: Estrogen replacement can help prevent bone loss. General factors that can help reduce the risk of osteoporosis include reducing or stopping smoking and alcohol intake; regular weight-bearing exercises; and taking calcium and vitamin D supplements. Bisphosphonates such as Fosamax (alendronate) reduce the risk of fractures, but they can cause damage to the esophagus. Selective estrogen receptor modulators, or SERMs, such as Evista (raloxifene), also reduce fracture risk. But SERMs can aggravate hot flashes and increase the risk of blood clots.

Concern: Alzheimer’s disease.
Alternative: Some clinical trials have shown that vitamin E delays some symptoms of Alzheimer’s disease and that gingko biloba slightly improves mental functioning in patients with dementia.

Concern: Vaginal dryness.
Alternative: Several options are available, including rings such as Estring; creams and waxy pessaries such as Estrace, Premenn, and Crinone; and small tablets such as Vagifem. Lubricants such as vitamin E suppositories or non-hormonal lubricants such as Replens, Senselle or K-Y jelly are also helpful. These moisturizers are also slightly acidic, which helps prevent vaginal infections. One other advantage is that they do not need to be used at the time of intercourse. Some women have found a Tea tree oil based product helpful.

Concern: Incontinence.
Alternative: Doing Kegel exercises, which strengthen pelvic floor muscles, and most estrogen vaginal creams. For very active women, there are several FDA-approved devices (such as Fem-Assist or the Reliance Urinary Control Insert) that are placed temporarily in or over the urethra.
If HRT use cannot be avoided, the U.S. Food and Drug Administration in 2003 stated the therapy should only be used in the lowest possible doses for the shortest possible time.

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