Many women use nonhormonal prescription medications to combat the initial symptoms of menopause, including hot flashes, insomnia, sexual dysfunction, depression, mood swings, and fatigue. Medical treatments and preventatives for some physical conditions such as cholesterol imbalances, high blood pressure, bone loss, and vaginal dryness also are available. This section offers a brief overview of some of the most widely prescribed and effective nonhormonal prescription medications in use for the treatment of menopause symptoms. Check with your health care provider about what he or she might be willing to prescribe for you.

For Hot Flashes and Night Sweats

As discussed in Chapter 5, even though MHT is still considered the gold standard for treatment of hot flashes and vasomotor symptoms, there are several nonhormonal remedies for hot flashes. For women avoiding hormones, prescription drugs such as clonidine, some antidepressants, and gabapentin can offer significant relief from hot flashes. Herbal remedies are mentioned later in this chapter.

For Blood Pressure and Cholesterol Management

Although estrogen has been shown to be an effective tool for normalizing cholesterol levels in women as they pass through menopause, it is not a good treatment for high cholesterol.

Diet and exercise are your two most effective means for controlling cholesterol levels and blood pressure. But many medications are currently available to treat both conditions:

• The so-called “statins” (Simvastatin, Pravastatin, and Lovastatin) are very effective in lowering cholesterol levels and preventing deaths due to heart disease. These drugs can interact with some other medications, and they aren't recommended for people with active liver disease.

• Diuretics flush water and sodium from the body and can be effective for reducing blood pressure. They reduce the level of fluid in your bloodstream and help remove sodium from your circulation, so they may help open up and boost the capacity of your arteries, which lowers the blood pressure against your arterial walls.

• Beta-blockers, including lopranolol and metoprolol, block some of the nerve impulses to the heart, making the heartbeat slower and the heart's workload decrease.

• ACE inhibitors are also effective in controlling high blood pressure, and they seem to work by inhibiting the formation of a substance that causes blood vessels to constrict.

• Calcium channel blockers slow the movement of calcium into the blood vessels and heart cells, relaxing the vessels and increasing the amount of blood to the heart. They are often prescribed to reduce blood pressure, but they also slow the heart rate and can make you drowsy until you get used to them.

High blood pressure medications have a range of possible side effects, and most doctors recommend lifestyle changes as a first line of defense against this disease.

For Managing Bone Loss

Though estrogen is the undisputed queen of bone maintenance, medical science has made a number of strides in finding alternative drugs that slow the bone loss associated with menopause. Weight-bearing exercise and a diet rich in calcium and vitamin D are important components of any plan to maintain good bone health. For details on medications used to fight osteoporosis, see Chapter 15.

For Combating Insomnia, Depression, and Anxiety

Though thousands of people in the United States suffer from sleep disorders, insomnia becomes a true enemy of women as they approach menopause. Hormonal fluctuations lead to night sweats and mild panic attacks that can blast a woman out of a sound sleep at 3 a.m. and keep her awake for hours.

Lifestyle changes are essential to guarding your sleep and leading a calm, rested, and energetic life. Exercise, stress-management techniques, and a diet low in caffeine and alcohol all are important components of any plan to maintain deep, restful sleep and emotional health. Though doctors sometimes recommend MHT for the relief of insomnia, depression, and anxiety, a number of medications are also available to help menopausal women combat these debilitating conditions.

Insomnia treatment is detailed in Chapter 7, so consult that chapter for details on the use of several medications.

Treatment of depression may be achieved with the same lifestyle choices mentioned previously, including healthy diet, regular exercise, and daily sunlight. Additionally, there are many medication choices such as selective serotonin reuptake inhibitor (SSRI) antidepressants (see Chapter 8 for more detail on treatment of depression). Your health care provider may refer you to someone familiar with medication choices if depression is a major symptom during menopause.

Anxiety can be treated with anti-anxiety drugs such as buspirone and alprazolam. These medications, called anxiolytics, also can treat the symptoms of premenstrual dysphoric disorder (PMDD) that many perimenopausal women experience as they move closer to menopause. These drugs can have a slightly sedative effect, so many health care professionals prescribe them only for short periods of time.

Prescription medications can offer true relief from many of the symptoms and physical conditions that result from perimenopause and menopause. But they aren't your only — and many times not even the best — answer. Some combination of prescription medications and/or hormone therapy may help temporarily treat many menopausal symptoms, but lifestyle choices are always the best tools for maintaining your health and emotional well-being. The following sections discuss supplemental vitamins and nutrients and a range of therapeutic programs that can also help keep you strong, fit, and healthy through menopause.