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Menopause: Is There Life Beyond Hormone Replacement Therapy?

Post-HRT, what are women doing to manage menopause symptoms? And are compounded bioidenticals safe?
WebMD Magazine - Feature

Menopause gets a bad rap, but there is an upside.

A major, essential, glorious one, says Renzie Richardson, a 51-year-old human resources consultant from Cumming, Ga. “I was definitely happy not to have a period anymore. That in itself was a celebration.”

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Still, the wider ramifications of going through The Change threw her for a loop. “I thought the period was gone -- that was it. But now you’ve got all these other symptoms you have to deal with.” Richardson was taken by surprise by hot flashes, thinning hair, vaginal dryness, fuzzy thinking, and weight gain. She was officially in menopause -- her periods had stopped for more than a year -- but the pesky symptoms continued.

And so Richardson found herself caught up in a quandary that binds millions of American women. Now that hormone replacement therapy (HRT) is no longer prescribed as widely as it once was, what does a woman do for menopause symptoms that range from annoying to miserable and downright disruptive? 

“I started doing a lot of research on what my options were, as opposed to hormone therapy,” she says, “because I was afraid of cancer and all this other stuff.”

Menopause: the natural passage

What are women to do? First, keep in mind that menopause is not a disease, but a natural passage that usually occurs between ages 45 and 54. “Puberty in reverse,” says Susan Love, MD, in Dr. Susan Love’s Menopause and Hormone Book: Making Informed Choices. While some women barely notice a blip, others feel the change throws their lives into disarray. 

“Menopause is a tough time for a lot of people,” says Mary Jane Minkin, MD, clinical professor of obstetrics and gynecology at Yale University School of Medicine, author of A Woman’s Guide to Menopause and Perimenopause, and an obstetrician/gynecologist in private practice. “Some breeze right through. Twenty percent of women get no hot flashes whatsoever.” But, she adds, many women are debilitated, “no matter how fabulously they take care of themselves.”

Not long ago, doctors routinely prescribed hormone replacement therapy to menopausal women, convinced of its power to relieve menopause symptoms and prevent heart disease and other ills. But women and doctors were stunned in 2002 when the NIH halted a Women’s Health Initiative study that indicated that long-term hormone use posed more health risks than benefits, such as an increased chance of heart attacks, strokes, and breast cancer.

Millions of women dropped conventional hormone therapy -- and droves have stayed away ever since. (Many others have turned to their doctors for a prescription for compounded bioidenticals, but are they safe? See below for more.)

“Patients are very reluctant. They’re very scared,” says Michelle Warren, MD, founder and medical director of the Center for Menopause, Hormonal Disorders and Women’s Health at Columbia University Medical Center. “There’s a whole different mindset out there.”

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