Treatment:

Treatment with hormones may be helpful if you have severe symptoms such as hot flashes, night sweats, or vaginal dryness.

Discuss the decision to take hormones thoroughly with your doctor, weighing your risks against any possible benefits. Pay careful attention to the many options currently available to you that do not involve taking hormones. Every woman is different. Your doctor should be aware of your entire medical history when considering prescribing hormone therapy.

If you have a uterus and decide to take estrogen, you must also take progesterone to prevent endometrial cancer (cancer of the lining of the uterus). If you do not have a uterus, progesterone is not necessary.

HORMONE REPLACEMENT THERAPY

Several major studies have questioned the health benefits and risks of hormone replacement therapy, including the risk of developing breast cancer, heart attacks, strokes, and blood clots.

Current guidelines support the use of HRT for the treatment of hot flashes. Specific recommendations:

• HRT may be started in women who have recently entered menopause.
• HRT should not be used in women who have started menopause many years ago.
• The medicine should not be used for longer than 5 to 7 years.
• Women taking HRT should have a low risk for stroke, heart disease, blood clots, or breast cancer.

To reduce the risks of estrogen replacement therapy and still gain the benefits of the treatment, your doctor may recommend:

• Using estrogen or progesterone regimens that do not contain the form of progesterone used in the study
• Using a lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream rather than a pill)
• Frequent and regular pelvic exams and Pap smears to detect problems as early as possible
• Frequent and regular physical exams, including breast exams and mammograms

ALTERNATIVES TO HRT

There are some medications available to help with mood swings, hot flashes, and other symptoms. These include low doses of antidepressants such as paroxetine (Paxil), venlafaxine (Effexor), bupropion (Wellbutrin), and fluoxetine (Prozac), or clonidine, which is normally used to control high blood pressure. Gabapentin is also effective for reducing hot flashes.

LIFESTYLE CHANGES

The good news is that you can take many steps to reduce your symptoms without taking hormones:

• Avoid caffeine, alcohol, and spicy foods
• Dress lightly and in layers
• Eat soy foods
• Get plenty of exercise
• Perform Kegel exercises daily to strengthen the muscles of your vagina and pelvis
• Practice slow, deep breathing whenever a hot flash starts to come on (try taking six breaths per minute)
• Remain sexually active
• See an acupuncture specialist
• Try relaxation techniques such as yoga, tai chi, or meditation
• Use water-based lubricants during sexual intercourse

Complications:

Postmenopausal bleeding may occur. This bleeding is often nothing to worry about. However, your health care provider should always check any postmenopausal bleeding. It may also be an early sign of other problems, including cancer.

Decreased estrogen levels are also associated with the following long-term effects:

• Bone loss and eventual osteoporosis in some women
• Changes in cholesterol levels and greater risk of heart disease

Calling your health care provider:

Call your health care provider if:

• You are spotting blood between periods
• You have had 12 consecutive months with no period and suddenly vaginal bleeding begins again