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Menopause Health Center

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Experts Lay Out Options for Menopause Symptoms

Evidence grows that antidepressants can help, new guidelines say


Years ago, doctors routinely prescribed hormone replacement therapy after menopause to lower women's risk of heart disease, among other things. But in 2002, a large U.S. trial called the Women's Health Initiative found that women given estrogen-progestin pills actually had slightly increased risks of blood clots, heart attack and breast cancer.

"Use of hormones plummeted" after that, Sulak noted.

But research since then has suggested that hormone therapy is safer for relatively younger women who start using it soon after menopause, the report notes. Women in that landmark study were in their early 60s, on average -- whereas U.S. women typically hit menopause at around age 51.

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.

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