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Experts Lay Out Options for Menopause Symptoms

Evidence grows that antidepressants can help, new guidelines say

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Experts now say that women should not take hormones to prevent any chronic ills. But when it comes to hot flashes, hormone therapy remains the most effective option.

Another ob/gyn agreed that doctors and women alike are often reluctant to consider hormones. "Since the [Women's Health Initiative], we've been like little fishes swimming upstream," said Dr. Jill Rabin, of Long Island Jewish Medical Center in New Hyde Park, N.Y.

To help minimize any risks, she said, it's important to keep the hormone dose at the lowest level needed to relieve a woman's symptoms.

Sulak agreed. "I'm an estrogen minimalist," she said. "I'm going to start you at a low dose, and that's enough for most women."

Women who should not try hormones, she noted, include those who've ever had breast cancer or a blood clot.

Hot flashes and night sweats are the most common menopause complaint. But vaginal dryness and pain during sex are also issues for many women.

The guidelines say that estrogen applied directly to the vagina -- in the form of creams, tablets or rings -- is effective. "Very little" of that estrogen gets into the bloodstream, Sulak said, so the risk of side effects is considered small.

And just this year, the FDA approved a new option for treating painful sex in postmenopausal women. It's a pill called ospemifene (Osphena), and it has estrogen-like effects on the lining of the vagina.

As for "natural" remedies, such as soy and black cohosh, studies have failed to prove they're effective for hot flashes and night sweats, the guidelines say.

However, Rabin said that some women who try supplements do feel better -- even if it's by a "placebo effect."

There are some "common sense" tactics any woman can use to help ease hot flashes, the guidelines say. Those include dressing in layers, keeping the thermostat lower at home and drinking cool beverages.

But for women who need more than that, Gracia advised talking to your doctor about the benefits and risks of all your options. "Therapy should be individualized, since one therapy may not be optimal for all women."

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