Midlife Meds

If 50 really is the new 30, then some thanks must go to the drugs that help ease the transition into midlife. These medications can protect you from debilitating conditions like bone loss and heart disease and make life bearable for those with severe symptoms of menopause. But it's important to remember that many of the drugs must be taken for years and they do have side effects. Laura DeFina, MD, a staff physician at the Cooper Clinic in Dallas who focuses on healthy aging, helps sort out what you need to know, and what you need to ask your doctor.

Hormone Therapy

Why You Would Want Treatment: By supplementing low levels of hormones, these drugs can relieve the worst symptoms of menopause, including hot flashes, night sweats, bone loss, and vaginal dryness. Estrogen/progestin pills can raise levels of hormones in the blood. Estradiol drugs (Estrace, Climara) are sometimes called bioidenticals; this synthetic hormone is chemically identical to estrogen made by a woman's ovaries (other bioidenticals may not be approved by the FDA).

Drawbacks: Immediate side effects can include breast pain, vaginal bleeding (if you experience this, get evaluated for uterine cancer), fluid retention, and headaches. Long-term problems can involve (to varying degrees) increased risk of breast cancer, blood clots, heart disease, and stroke. Bisphosphonates may cause stomach upset, ulcers, bone, joint, and muscle pain, headaches, and, rarely, jaw osteoporosis. SERMs can trigger hot flashes, leg cramps or swelling, blood clots, and flu-like symptoms.

Ask Your Doctor: ...what she thinks about starting with short-term therapy (typically two to three years with annual reassessments) on the lowest possible dose you can tolerate. Also, ask her how this might affect your risk of cancer. 

Osteoporosis Drugs

Why You Would Want Treatment: Bone density is hormone regulated and can decrease after menopause. If a bone scan reveals you have osteoporosis, you may be a candidate for treatment. Bisphosphonate drugs (Fosamax, Actonel) inhibit skeletal breakdown, resulting in maintained or increased bone density and strength. Selective estrogen receptor modulators (SERMs) like Evista offer another approach, acting as estrogen stand-ins to preserve and build bone.

Drawbacks: Bisphosphonates may cause stomach upset, ulcers, bone, joint, and muscle pain, headaches, and, rarely, jaw osteoporosis. SERMs can trigger hot flashes, leg cramps or swelling, blood clots, and flu-like symptoms.

Ask Your Doctor: ...to consider your risk of breast cancer; SERMs have been linked to a reduced risk of breast cancer in postmenopausal women. Discuss all the other ways you can protect bone, such as regular exercise (especially resistance training) and calcium and vitamin D pills (many doctors suggest 1,200 to 1,500 milligrams and 800 to 2,000 IU per day, respectively).

Cholesterol Medications

Why You Would Want Treatment: As hormones decrease and metabolism slows with age, the body processes cholesterol less efficiently. If the fats build up in your artery walls, they can restrict blood flow, increasing the risk of heart attack and stroke. Statins help lower cholesterol production in the liver. Other types of drugs include resins (which help the body dispose of cholesterol), selective cholesterol absorption inhibitors, niacin, and fibrates.

Drawbacks: Statin side effects include muscle aches, gastrointestinal disturbances, skin rash, and, occasionally, liver problems. Resins may cause bloating and constipation. Fibrates can cause nausea. Niacin may lead to flushing and stomach upsets.

Ask Your Doctor: ...if she thinks there are any lifestyle changes you could make first to lower cholesterol. If you begin treatment, be sure to clarify that it's to raise HDL ("good" cholesterol) and lower LDL ("bad" cholesterol) levels: The ratio of good to bad cholesterol is a better predictor of your cardiovascular health than total cholesterol.   

Hypertension Medications

Why You Would Want Treatment: Your hormones help keep blood pressure low, which may help explain why it typically rises after menopause—when women become more at risk for hypertension than men. Beta-blockers, ACE inhibitors, calcium channel blockers, and similar drugs relax blood vessels, giving blood more room to flow and thereby reducing risk for heart attack and stroke.

Drawbacks: Common side effects of beta-blockers and calcium channel blockers include fatigue and dizziness. ACE inhibitors may cause coughing and headache.

Ask Your Doctor: ...how low your blood pressure needs to drop, and how often you should come in for follow-up. Also ask about whether you should increase physical exercise as well as lower your intake of salt, caffeine,alcohol, and fat, all of which can raise blood pressure.

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