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Managing Menopause: What to Do?

Hormone Replacement Therapy May Be OK Short Term

Heart Health continued...

  • Get treatment for high blood pressure. Only about 20% of women have been effectively treated for blood pressure problems, says Seely. Medication can help. So can lifestyle changes such as weight loss, eating more fruits and vegetables, and exercise.
  • Get treatment for high cholesterol. Statin drugs have been shown to safely lower LDL "bad" cholesterol and reduce heart disease risk.
  • Get diabetes treated, or prevent it altogether through lifestyle changes such as weight loss, aerobic activity, and a better diet. One three-year study showed that lifestyle changes can decrease frequency of diabetes by 60%.
  • Lose weight. That's important for two reasons -- it decreases the risk of diabetes and heart disease.
  • Quit smoking. Heart disease risk is two to four times higher in women who smoke.
  • Get more exercise. Physical activity is shown in men and women to reduce heart disease risk by 30% to 50%.

Raloxifene (Evista) has been demonstrated to be effective against osteoporosis, says Seely. "The ongoing RUTH (Raloxifene Use for The Heart) trial will let us know whether it prevents heat disease but the answer will not be known for several more years," she adds.

Researchers have other questions about hormone replacement therapy, she says: Do some women, more than others, get greater heart disease benefit from HRT? Are there other forms of estrogen and progestin that could be heart disease-protective? Are there other progestins that could be more protective? Are lower doses of HRT beneficial for heart disease? Does the route of administration matter -- would an HRT patch work better and more safely? And what about for women that can take estrogen alone?

Quality of Life

Hot flashes, mood changes, lost sleep, decreased sexual interest, vaginal changes such as dryness -- "Quality of life is big issue for many women," says Charles Hammond, MD, chairman emeritus of obstetrics and gynecology at Duke University School of Medicine.

"For many women, symptoms often worsen in every category -- except for depression -- as she ages," he says. "This does not occur in all women by any means, but it does in many."

The vast majority of women, more than 60%, take hormone replacement therapy to relieve these symptoms, he says. In fact, some women will have these symptoms for up to a decade, possibly longer.

While short-term therapy would be a solution for the majority, what should the others do? There are plenty of unanswered questions about hormone replacement therapy, says Hammond.

Here's what works and what does not:

  • Phytoestrogens and isoflavones in soy foods have been studied to a limited extent, and they do not seem effective in controlling hot flashes.
  • Lifestyle changes, layered clothing, keeping the bedroom cooler -- those all help.
  • Black cohosh has not been shown to help. Also, because such supplements are not FDA approved, there is a risk that the compound is not pure.
  • Antidepressant drugs have shown some benefit in relieving hot flashes and improving sexual interest. But it's too early to suggest those drugs as a first line of treatment, says Hammond.
  • New "estrogen rings" that are inserted in the vagina -- and topical cream -- will help with vaginal dryness.

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