 Birth control and contraception methods offer women confusing choices. The pill or patch, condom or cap, injections or implants, each form of contraception has effects and side effects that are as important to the user as the reliability of pregnancy protection. Clinical trials of new oral contraception formulations are underway to improve breakthrough bleeding and reduce pregnancy rates on the “pill”.
Hot flashes, vaginal dryness, mood changes, decreased libido, and bone loss are part of a host of symptoms some women face during menopause. The effect of hormone replacement, both estrogens and progestins, has been tremendously controversial since the Women’s Health Initiative, a large medical study which suggested that the health risks associated with hormone replacement therapy are outweighed by potential benefits. Since then research studies have been ongoing to develop therapies that provide relief with a good safety profile.
Hormone levels start to fluctuate as part of the perimenopause as women move into their mid-forties. While the average women reaches menopause around age 51, symptoms such as hot flashes and mood swings begin well before the last menstrual period. In the course of investigation of treatments for anxiety and depression, certain antidepressants have been found to relieve symptoms of hot flashes and others may enhance low libido. Many antidepressants can aggravate these conditions so only certain medications are being studied in clinical research for these indications.
Not all women experience significant changes in their sex drive or sexual response as they age, however, some women find that arousal is more difficult or that desire is less intense than previously. Research studies to evaluate the effectiveness of medication to enhance either sexual desire or sexual response are underway. These studies are difficult to perform because of the confounding factors that are part of a women’s sexual response. The placebo (“sugar pill”) effect is high, as most women desire help and want the treatment to make them better. In order for a medication to be considered effective it must perform better than placebo in a clinical trial. In studies of sexual arousal in women, placebo was effective up to 35% of the time. It has been hard to develop an intervention for sexual arousal and sexual desire in women that is better than placebo. Hormone combinations of estrogen and testosterone have been proven effective but the health issues associated with testosterone use over time cause concern. Bone density loss, osteopenia followed by osteoporosis, is a common condition familiar to women as they watched their mothers bend with age. Estrogen is a powerful bone stabilizer and the loss of natural estrogens that occurs at the menopause accelerates bone loss in the first 10 years of menopause. After the first ten years of menopause, bone loss continues but the rate of change is less dramatic. It is in the first few years of menopause that a women’s risk for osteoporosis should be assessed by a simple scan called a bone densitometry. Research studies compare the safety and effectiveness of non-hormonal treatments.
top |
