Estrogen has dominated the prescription drug market for years. Premarin in particular is the most prescribed medication in America. Millions of women take this oval tablet every day.
Initially, Premarin's popularity was due to its ability to relieve menopausal symptoms, especially hot flashes and night sweats, but many doctors are now prescribing it just as much for its value in preventing osteoporosis.
Women lose bone rapidly around menopause. Scientists concluded that estrogen-replacement therapy could be beneficial against osteoporosis. Subsequent studies confirmed that this regimen can, indeed, protect against devastating hip and spine fractures in older women.
In addition to osteoporosis, estrogen may help protect older women against heart disease, Alzheimer's disease and possibly even colon cancer. It is little wonder, then, that the leading brand, Premarin, is so widely used.
Doctors are often distressed, though, that women stop taking estrogen-replacement therapy. In spite of its obvious benefits, many women worry that estrogen will increase their risk of breast and uterine cancer. They also do not appreciate the inconvenience of continuing to experience menstrual periods well after menopause.
That is why there is such intense interest in alternatives to estrogen. One recent drug that provides bone benefits is Fosamax (alendronate). This non-hormonal medication has been shown to strengthen bones and protect against fractures in women who take it.
Although it is still fairly new, sales are skyrocketing. Fosamax is, however, somewhat inconvenient to take, because it must be swallowed with plain water at least half an hour before breakfast. Some patients on this medication have developed serious esophageal irritation.
Excitement is building for the expected approval of another drug, raloxifene, to be sold under the brand name Evista. This estrogen-like compound is more targeted to bones than traditional hormone therapy.
Raloxifene improves bone density and may offer women cardiovascular benefits as well. It brings bad LDL cholesterol and total cholesterol down without affecting beneficial HDL cholesterol. Unlike estrogen, raloxifene does not appear to stimulate breast tissue or increase the risk of uterine or breast cancer. There is even a possibility that this new drug may cut women's risk of breast cancer. Side effects include hot flashes, leg cramps and, rarely, blood clots.
When it becomes available, raloxifene will offer women another option to estrogen and Fosamax. Women looking for alternatives have already made herbal medicines for menopausal symptoms and phytoestrogens from foods such as soy popular over the last several years.
Although osteoporosis prevention may seem more confusing than ever, women have more choices so that they can take their individual and family histories into account. Evista will be a welcome addition to the range of treatments.
"Our Guide to Estrogen: Benefits, Risks & Interactions" pulls together what women should know about hormone therapy, raloxifene and the herbal alternatives many women are exploring. Anyone who wants a copy can send $2 with a long (No.10) stamped, self-addressed envelope to Graedons' People's Pharmacy, No. WR-197, P.O. Box 52027, Durham, NC 27717-2027.
Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Send questions to them at People's Pharmacy, c/o King Features Syndicate, 235 E. 45th St., New York, NY 10017, or e-mail PHARMACY@mindspring.com.