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    Hormone Therapy for Menopause and Perimenopause

    If You Have Joint Pains

    When millions of women stopped hormones after the WHI report in 2002, some doctors were suddenly fielding fears about arthritis, says Dr. Richardson. Kathleen Kalell, who started HT in her mid-40s for hot flashes, has been on and off several times in more than a decade. “Each time I go off, my mobility is really impaired,” she says. Exercising and even climbing stairs become difficult because of her knee pain.

    Will hormones help? HT is controversial here — taking hormones for joint pain is definitely an off-label use — but there are women and gynecologists who swear by it. “I don’t look like I’m 200 years old when I’m walking,” says Kalell. If achiness is your only symptom, talk to your doctor about other possible causes and other forms of relief first.

    If You Are Moody

    Hormonal spikes and dips may prompt bursts of irritability, anxiety, depression, and overall moodiness. “It’s very much like PMS, but no longer confined to the week before your period,” says Dr. Gass. “It’s one thing to cope with it one week out of the month. Dealing with it randomly — and sometimes many times a month — is more exasperating.” But don’t discount other familiar midlife stressors, like combined demands of tweens, teens, work, and aging parents, particularly if you’re also struggling with hot flashes and your sleep is disrupted.

    Will hormones help? Most women actually feel quite a bit better once they’ve made it into the stable hormonal state of menopause, notes Dr. Richardson. But if you can’t wait till then, talk to your doctor about which options make sense for you. Depending on other symptoms, you might take birth control pills to level out hormones during perimenopause, then, if you’re still feeling out of sorts once your periods stop, switch to systemic HT. Some women also benefit from antidepressants or antianxiety medications, along with talk therapy or holistic strategies.

    When (and How) to Get Off HT

    Here’s the mantra: the lowest effective dose for the shortest time possible. And, some doctors add, for no longer than three to five years. Sounds good, but as much as half the time, symptoms recur when you stop, no matter what your age or how long you used HT. So what then?

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