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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?

The truth about HRT

So where does that leave women who still need relief? They can try nonhormonal therapies first (more on these below), but if these attempts don’t work, the news about hormone therapy isn’t uniformly bad.

Doctors now use hormone therapy to relieve moderate to severe menopause symptoms but at the lowest dose that works for the shortest time needed. When women start hormone therapy within 10 years from the time they enter menopause, heart disease risk doesn’t seem to rise. In fact, preliminary evidence suggests that hormone therapy taken for menopause symptoms in the first few years of menopause may even help to protect the heart. But the longer a woman waits to start hormone therapy after menopause, the higher the risk of heart disease.

Doctors continue to prescribe hormone replacement therapy when benefits outweigh risks for women grappling with disruptive hot flashes or night sweats that lead to insomnia and irritability. “Estrogen still is the most effective intervention for just about all the symptoms of menopause, no question about it,” Minkin says.

But because of the potential for serious problems, menopausal women considering hormone therapy should carefully discuss individual risks and benefits with their doctor. For example, women who have had breast cancer would not be good candidates. Besides hormone therapy, some doctors prescribe antidepressants, which have worked moderately well to relieve hot flashes in clinical trials.

Finding a doctor with menopause expertise can help women come up with a good plan, says Karen Giblin, founder and president of Red Hot Mamas, a national menopause education group. A starting point: The North American Menopause Society’s website, which lists doctors who have earned menopause credentials from the organization. 

Birth control pills for perimenopause

Another HRT alternative for women on the road to menopause: low-dose birth control pills, believe it or not, are also good for calming dreaded hot flashes and heavy or irregular bleeding.

A perimenopausal woman isn’t officially in menopause until she has gone 12 months without a period. In the several years leading up to that milestone, a woman ovulates less and can produce less estrogen and progesterone. “We’re not ovulating as well and our estrogen levels are variable,” says Minkin. “Your hormones look like the Dow Jones industrial average -- especially these days: up, down, up, down.” Symptoms fluctuate with the wild hormonal swings, she adds.

Birth control pills or patches “put your ovaries to sleep,” she says. They take over delivering hormones. When estrogen levels are steadied this way, hot flashes and other menopause symptoms often improve, according to Minkin. (Some women, though, should avoid all birth control pills, including very-low-dose kinds: smokers over age 35, women with uncontrolled high blood pressure, and women who have had breast cancer, heart disease, or deep blood clots.)

Very-low-dose birth control pills are sometimes a better option than hormone therapy because they shut down the ovaries, Minkin explains. In contrast, perimenopausal women on hormone therapy might still have irregular cycles and bleeding.

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