Osteoporosis
and Bone Loss

Adult Female
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Category	Prescription Drug	Amount	Cost
Women's Health	Diflucan (yeast) Estradiol (estrogen) Evista (osteoporosis) Naprosyn (pain relief) Seasonale (hormones) Vaniqua (facial hair)	150 mg - 3 tablets 1 mg - 30 tablets 60 mg - 30 tablets 500 mg - 60 tablets 0.15 mg - 1 month 13.9% - 30 gm tube	$89 $48 $156 $49 $58 $75

Diflucan (yeast infection)

Diflucan is indicated for the treatment of vaginal candidiasis (vaginal yeast infections due to Candida), oropharyngeal or esophageal candidiasis and cryptococcal meningitis. Diflucan is also used to decrease candidiasis in patients undergoing bone marrow transplantation who receive chemo or radiation therapy.

Estradiol (estrogen replacement)

Use Estradiol to reduce moderate to severe menopausal symptoms, to treat vulval and vaginal atrophy, treat cancer in special situations and prevent the thinning of bones. Estradiol contains the hormone estrogen.

Evista (osteoporosis)

Evista is a prescription medicine used by women after menopause to treat or prevent osteoporosis. You should take calcium and vitamin D along with Evista if you do not get enough calcium from your diet.

Naprosyn (pain relief, arthritis)

Naprosyn is indicated for the treatment of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, tendonitis and bursitis, and acute gout. It is also generally indicated for the relief of mild to moderate pain.

Seasonale (hormone replacement)

Seasonale is for hormone replacement and oral contraception. It is sold in 3 month packets with one pill for each day. Seasonale has a low hormone dosage of just 0.15 mg per day. Do not skip pills even if you are spotting, bleeding or feel sick to your stomach.

Vaniqua (facial hair)

Vaniqua cream is a medication applied to the skin for the reduction of unwanted facial hair in women. Vaniqua interferes with an enzyme found in the hair follicle of the skin needed for hair growth. This results in slower hair growth and improved appearance where Vaniqua is applied.

More Information:   [Yeast Infection]    [Osteoporosis]    [Facial Hair]    [Menopause]    

Vaginal yeast infections are caused by a fungus called Candida albicans. Yeast are tiny organisms that normally live in small numbers on the skin and inside the vagina. The acidic environment of the vagina helps keep yeast from growing. If the vagina becomes less acidic, too many yeast can grow and cause a vaginal infection. The acidic balance of the vagina can be changed by your period (menstruation), pregnancy, diabetes, some antibiotics, birth control pills and steroids. Moisture and irritation of the vagina also seem to encourage yeast to grow.

Yeast infections can be very uncomfortable, but are usually not serious. Symptoms include:

Itching and burning in the vagina and around the vulva
A white vaginal discharge that may look like cottage cheese
Pain during sexual intercourse
Swelling of the vulva

Yeast infections are so common that 3/4 of women will have one at some time in their lives. Half of all women have more than one infection in their lives. If you have symptoms of a yeast infection, your doctor will probably want to talk to you about your symptoms and examine you to make sure a yeast infection is the cause.

Yeast infections are usually treated with medicine that you put into your vagina. This medicine may be a cream that you insert in your vagina with a special applicator, or it may be a suppository that dissolves on its own. Medicine in a cream form can also be put on your vulva to help relieve itching. Medicine taken by mouth is also available.

Be sure to see your doctor the first time you have symptoms of a yeast infection. It's very important to make sure you have a yeast infection before you start taking medicine. The symptoms of a yeast infection are also the symptoms of other infections, such as some sexually transmitted diseases. Treating yourself for a yeast infection when you actually have another type of infection may make the problem much worse.

Bone is a living tissue, constantly renewed through a natural process in which new bone replaces old bone. As we age, the process becomes less efficient and we begin to gradually lose bone. In someone with osteoporosis, bone loss occurs more rapidly, causing the bones to become very thin and weak over time. When bones become severely weakened by osteoporosis, simple movements – such as bending over to pick up a heavy bag of groceries or sneezing forcefully – can lead to fracture. Wrist, spine and hip fractures are the most common fractures associated with osteoporosis. Hip fractures related to osteoporosis are a serious problem in seniors, resulting in death in up to 20 percent of cases and disability in up to 50 percent of those who survive. Following a hip fracture, many seniors can no longer live independently, and may require nursing home care.

Women are especially at risk of osteoporosis because of the important role that the hormone estrogen plays in keeping their bones healthy. At menopause, estrogen levels fall dramatically, and many women experience an accelerated rate of bone loss. Although men usually have a greater bone mass than women, they are not immune. As they age, they also lose bone mass and should follow the lifestyle changes recommended to prevent or delay osteoporosis.

Individuals over the age of 50 need 1000 to 1500 mg of calcium each day. As you age, your body doesn't absorb calcium as well, so it's very important to have calcium-rich foods in your diet. If you don't eat enough calcium-rich foods, you may require a calcium supplement. Here are some low impact ideas to increase your calcium intake. Add a few tablespoons of milk powder to your beef patties, oatmeal, mashed potatoes, creamy soups and other casseroles (2 to 4 tablespoons). Add sesame seeds, sunflower seeds, cheese cubes or dried figs to your salads. Spread blackstrap molasses on your toast or add to baked beans. Replace your morning coffee with a café au lait or a hot chocolate milk.

You also need to get enough vitamin D. Calcium is not easily absorbed by the body without vitamin D. Sunlight is the main source of natural vitamin D. Most seniors don't get enough of this vitamin, and a daily supplement of 400 to 800 IU may be recommended (especially where there's little sun intensity during the winter months).

Be active every day. Your bones react to increased activity by getting stronger. Regular weight-bearing activities such as dancing, walking, hiking and tennis are recommended. In addition, exercise that improves balance and coordination (tai chi, swimming and flexibility exercises) can help reduce falls and fractures. Keep experimenting until you find an activity that's right for you! And avoid smoking. Smokers have faster rates of bone loss and a higher risk of fractures than non-smokers. Women smokers also tend to enter menopause at a slightly younger age than non-smokers. This causes the period of rapid bone loss to occur at an earlier age.

More women have excessive facial hair, or think they do, than you might expect. Approximately 20 million American women remove facial hair at least once a week, according to research done by Bristol-Myers, a manufacturer of health and grooming products. An increase in facial hair can have many causes and usually isn't due to any serious imbalance of hormones. Often it's simply a normal side effect of aging. But how can you tell when it's normal and when it's a reason to see your doctor?

Hormonal changes in a woman's body through her life will cause changes in her hair type and how it's produced. Before puberty, facial hair is a fine, thin type known as "vellus." With the onset of puberty, hormones transform some hair to a coarse pigmented variety called "terminal." The appearance of terminal hair in the pubic and axillary (under the arm) regions is caused by male hormones that are produced in puberty. For some women, terminal hair begins to replace vellus hair on the face. When they compare their facial hair at age 40 with what it was at age 20, many women note subtle increases that they may deem abnormal or cosmetically disturbing. These increases may be bothersome, but they're generally part of the normal skin changes associated with aging, and aren't connected with an increase in male hormone levels. At menopause, the ratio of male hormones (androgens) to estrogen may change, and this can produce mild increases in facial hair. Finally, if a woman's mother or father has a good amount of facial hair, chances are that she will, too. Heredity dictates how thickly hair follicles are distributed through the skin, and this is fixed at birth. Certain ethnic groups are more likely to develop facial hair than others, so heavy facial hair is quite normal in some families.

The disorder in which excessive hair growth is stimulated by androgenesis is called hirsutism. Hirsutism can be accompanied by other changes, such as balding, deepening of the voice and cessation of menstruation. In other words, excessive hair growth is usually not the only symptom of a true medical disorder. Most hirsutism is caused by overproduction of androgens from one of the two natural sources of androgens in women: the ovary or the adrenal gland. The predominant androgen from the ovary is testosterone, while DHEA, currently marketed as a dietary supplement , comes from the adrenals. Simple blood tests that measure DHEA and testosterone can pinpoint the source of the trouble.

When the cause is elusive, birth control pills can be used to limit hair growth. The birth control pill works by rendering some of the circulating androgen inactive. Adrenal hyperplasia is treated with a different hormonal antidote. A number of other medications have proven helpful. Spironolactone, a diuretic, inhibits androgen production. Ketoconazole, an anti-fungal drug, also blocks the creation of male hormones. For women with minimal facial hair, there are a number of options, but all have drawbacks. Temporary solutions such as shaving and depilatories can irritate skin. Electrolysis is costly and uncomfortable, but it does yield results. Laser therapy is similarly costly, and it should be used with caution by women with dark skin, since permanent skin blotching can occur. The most encouraging development is a cream called Vaniqua, which was submitted to the U.S. Food and Drug Administration for approval in October 1999. Vaniqua, manufactured by Bristol-Myers Squibb and Gillette, is said to prevent hair growth with frequent use.

The menopause, also called the change of life, is defined as the end of the last menstrual period. In Western women it occurs on average at 51 years, but there is a wide range of normal extending from your 30s to 60s. The menopause occurs when the ovaries no longer respond to the controlling hormones released by the pituitary gland of the brain. As a result, the ovaries fail to release an egg each month and to produce the female sex hormones estrogen and progesterone. It is the fall in the levels of these hormones in the bloodstream that gives rise to the symptoms of menopause.

Every woman experiences the menopause differently. Many hardly notice 'the change', except perhaps their periods become irregular. Others suffer every symptom and find their lives are severely affected. The transition into the menopause is usually gradual and is accompanied by a range of symptoms.

Hot flushes and Sweating

The most common symptoms by far are ‘hot flushes’ and sweating attacks. These episodes can happen at any time, as often as several times an hour. Each hot flush usually lasts for three to six minutes. Exactly why flushes and sweats occur is not fully understood, but mostly it is because the automatic controls of the nervous system become erratic. This triggers the skin blood vessels to open and signals the sweat glands to become active at any time. Usually, this would only happen if you were too hot and needed to lose heat.

Sleep and Depression

Sleeping difficulty can be due to problems falling asleep, restlessness or night-time sweats. Some women sweat heavily and have to get up to change the sheets several times a night. Depression, mood swings, tiredness or headaches are all possible symptoms. Forgetfulness or irritability can be distressing for both you and the rest of the family.

Physical Changes

During the menopause your skin becomes thinner. A lack of estrogen often means the glands in the vagina don't produce as much lubrication as before and this may cause stinging around the vagina during sex. Some women don't feel like having sex, whereas others find their orgasms become less intense. The lack of estrogen also affects the bladder and you may find you need to pass water more often. There is a gradual rise in the risk of heart disease and stroke after the menopause. Falling estrogen levels result in unfavourable changes in cholesterol and fat levels in the blood, causing a predisposition to these problems.

Osteoporosis

In recent years there has been a lot of interest in osteoporosis (thinning of the bones) in connection with the menopause. Estrogen normally stimulates the bone-building cells. As a result of the drop in estrogen, women tend to lose bone mass and strength for several years following the menopause. Ultimately, this can make the bones more likely to collapse or fracture.

Help for Menopause

Hormone replacement therapy (HRT) alleviates the symptoms of the menopause by adjusting hormone levels. It involves receiving a small daily dose of estrogen. Women who have not had a hysterectomy are also given a progesterone-like drug as part of the HRT. This is called combined HRT. Combined HRT can be described as either sequential or continuous.

Sequential combined HRT is suitable for women who are perimenopausal, still experiencing erratic menstrual bleeding. Most preparations are designed to mimic the menstrual cycle and result in monthly periods. They are based around a 28-day cycle in which estrogen is taken every day and a progesterone is added for the last 12 to 14 days of the cycle. For women who are borderline postmenopausal and have very infrequent bleeds, there is also a sequential preparation available that results in three-monthly bleeds.

Once a woman has not had a natural period for a year and is described as postmenopausal, continuous combined HRT is more suitable. This form of HRT does not produce periods and involves taking a daily dose of estrogen and progesterone.

There are many ways of taking HRT, with the most usual being a daily tablet. Alternatives include skin patches, a small pellet or implant under the skin, a gel applied daily to the skin, a ring inserted into the vagina, or a nasal spray. The majority of women have no major side effects, but the following are fairly common at the beginning of therapy:

nausea
breast tenderness
weight gain
fluid retention.

HRT is effective at relieving hot flushes and vaginal dryness and many women report an improvement in their general sense of wellbeing. However, HRT is not a magic fix and if disturbed mood or behaviour is due to underlying problems at home or work, HRT cannot be expected to improve matters. HRT is often taken for a short spell of six months to a year to relieve hot flushes. The long-term benefits of HRT have recently been brought into question. Previously it was thought that HRT prevented heart disease and strokes by slowing the development of hardening of the arteries. Several major research studies reported in 2002 and 2003 have shown this is not so. The possibility that HRT users are less likely to develop Alzheimer's disease is still to be confirmed, but it does seem that HRT offers some protection against developing bowel cancer. The most important result of these research studies has been the confirmation that HRT increases the risk of developing breast cancer and endometrial cancer (cancer of the lining of the womb).

Hysterectomy and Endometrial Ablation

Hysterectomy, complete removal of the uterus, is a relatively major operation. This means it is accompanied by risks such as those of an anaesthetic, of bleeding at operation, wound infection and vein clots. However, these are risks that apply to any operation. In practice, hysterectomy is a successful and well-tolerated procedure. Heavy menstrual bleeding is the most common reason for having a hysterectomy. One in five women have had a hysterectomy before the age of 60.

Lesser surgical procedures to treat heavy bleeding are now possible using fibre-optic instruments that can destroy the lining of the uterus (endometrial ablation). This works because it is only the inner lining of the uterus that is hormone-sensitive and responsible for menstruation. The procedure does not completely remove every piece of the uterine lining, and 30-90 per cent of women still get some menstrual bleeding afterwards, but usually it is light. For the same reason, if you later take hormone replacement therapy (HRT) after an endometrial ablation, you will still need to use a combined HRT preparation and not just estrogen alone.

Natural Remedies

Regular exercise such as walking for 20-30 minutes three or four times a week can improve your health and add years to your life. Exercise strengthens your bones, increases wellbeing and can help make sleeping easier.

Eating the right food is also important. For healthy bones, the body needs about 1500 mg of calcium each day from dairy products such as milk products and cheese.

Eating plenty of fruit and vegetables provides the necessary minerals and vitamins for good general health and also helps to protect against cancer and heart disease.

Smoking is never good for your health. Stopping smoking is the biggest single move anyone can make to improve their health, whatever their age.

Disclaimer

This drug information is for educational purposes only. It is not intended that this information covers all uses, directions, drug interactions, precautions, or adverse effects of your medication. This is only general information, and should not be relied on for any purpose. It should not be construed as containing specific instructions for any particular patient. We disclaim all responsibility for the accuracy and reliability of this information, and/or any consequences arising from the use of this information, including damage or adverse consequences to persons or property, however such damages or consequences arise. No warranty, either expressed or implied, is made in regards to this information.