Searching for alternatives

Call it one more side effect of hormone replacement therapy. For years, the drugs looked so good that researchers and pharmaceutical companies had little incentive to look for other treatments that would relieve the symptoms of menopause. That has left women with few good alternatives to the hormones, even as worrisome tidings from the Women's Health Initiative accumulate.

Those findings, however, are spurring new research aimed at helping menopausal women without increasing their risk of disease, specialists said yesterday. "There are a number of agents in development that are not hormonal," said Dr. James Simon, president of The North American Menopause Society. "It just takes time and money."

Some researchers are finding that antidepressants such as Prozac and Effexor may help with hot flashes, Simon said.

At Wyeth Pharmaceuticals, the biggest maker of hormone therapy drugs, the search for an alternative is "not back-burner stuff," said Dr. Victoria Kusiak, North American medical director.

The first drug likely to emerge from development is a "specific estrogen receptor modulator," she said. Some researchers believe that SERM drugs could become the next generation of menopause therapy. Because they act differently on different parts of the body, it might be possible to find just the right one for a patient at high risk for breast cancer or uterine cancer, for examples.

Other researchers and doctors predict that the future lies in more customized treatments for menopausal symptoms, whether through using more specific estrogen drugs, other hormones, or symptom-specific herbs. For many years, menopause specialists assumed that the two hormones, estrogen and progestin, given in standard therapy were the answer, because they are obviously lost when the ovaries fail, said Jonathan L. Tilly, director of the Vincent Center for Reproductive Biology at Massachusetts General Hospital.

But "that's a very naive thought," he said. "It's clear from my vantage point that the ovaries produce hundreds of different hormones and factors. Obviously estrogen and progestin are important, but clearly they're not the only things lost when the ovaries fail at menopause."

Carey Goldberg can be reached at goldberg@globe.com.