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    Managing Menopause: What to Do?

    Hormone Replacement Therapy May Be OK Short Term

    Quality of Life continued...

    "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.

    Estrogen helps relieve symptoms, but would estrogen via a patch be safer as a long-term therapy? Research of the patch does not show as "robust" effectiveness as the pill, Hammond reports. Also, more research is needed of the progestin family of drugs. "We probably know less about progestin than estrogen."

    "Each patient has to balance risks and benefits of hormone replacement therapy," he says. "Short-term use does not increase the relative risk of breast cancer.""

    The verdict: "I see women every week whose quality of life is so poor, that I think there is still a place for estrogen until something better comes along," says Hammond.

    Brain Function

    "No protective effect against dementia" -- that was the WHI finding.

    But further study has pointed to a different scenario for younger women, reports Hadine Joffe, MD, psychiatry instructor at Harvard Medical School.

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