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Is Hormone Replacement Therapy Right for You?

By Paula Spencer Scott
WebMD Feature

Treatments for menopause symptoms have come and gone. Once, hormone therapy was the second most prescribed drug in the U.S. Then in 2002, a major study found problems and doctors backed off prescribing it. Now you hear a lot about both hormonal and nonhormonal treatments for menopause, including bioidentical hormones. What's right for you?

Hormone therapy involves taking estrogen plus, in most cases progestin. Progestin helps lower the risk of getting endometrial cancer from taking estrogen.  Women without a uterus usually get just estrogen.

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Hormones are given in different ways and for different reasons:

  • By pill
  • Through the skin via patch, cream, gel, or spray
  • Vaginal cream, ring, or suppository

Nonhormonal treatments include herbs, foods, drugs, and behavior or lifestyle changes. There's one FDA-approved nonhormonal medication for hot flashes, an antidepressant.

To decide which course is best for you, think about these questions:

What's your goal?

Menopause is a natural passage all women go through. Hormone therapy can't improve your overall health or protect your heart or brain, as doctors once thought. Still, many women choose treatments to lessen menopause symptoms that bother them.

What are your symptoms?

Women often use hormones to treat hot flashes and bone changes. Over-the-counter lubricants and moisturizers can treat vaginal dryness that often leads to painful sex. Or you can ask your doctor about prescription oral drugs or vaginal creams and rings.

You may also have trouble sleeping, dry skin, thinning hair, mood swings, and acne. There are different approaches for each of these symptoms. For example, losing weight and learning to avoid hot-flash triggers can help you have fewer of them. More exercise and good sleep habits can help with trouble falling or staying asleep.

Some women swear by over-the-counter herbal products ("botanicals") like soy or black cohosh. Studies have not found them to work, though, and they are not FDA-approved.

How severe are your symptoms?

Some women sail through menopause with few symptoms or none that upset their daily life. One in 4 women, for example, don't feel hot flashes. For mild problems, efforts to cut stress and boost a healthy lifestyle can get you through.

Other women turn to hormone therapy because menopause symptoms disrupt their sleep and daily life. The rule of thumb today is that the risk of health problems is low for most women when hormones are used at the lowest dose for the shortest time -- about 3 to 5 years.

What are a treatment's side effects?

Choosing a treatment involves thinking about your whole life and what you can or can't endure. Steps like cutting stress or dropping weight to sleep better and manage hot flashes will also boost your overall health.

Other choices are more complex. Depression drugs also work well against hot flashes for some, for example. However, they can curb sexual desire and have other effects such as nausea and weight gain.

Estrogen-progestin hormone therapy carries a raised risk of breast cancer, stroke, and deep-vein thrombosis.

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