Six years ago, a major study on hormone replacement therapy (HRT) revealed that it could raise the risk of breast cancer, blood clots, stroke, and heart disease. Thousands of women tossed their pills and many more never even considered beginning the treatment. Further research suggests this reaction may have been rash—HRT still makes sense for a lot of women.
"If you look at the science carefully enough, the two-to-five-year period that most women need HRT to get through this transition is relatively safe," says Michelle Warren, MD, medical director of the Center for Menopause, Hormonal Disorders and Women's Health at Columbia University. In the research, breast cancer risk didn't rise until after five years of use. In other research, if women began taking HRT within ten years of entering menopause, their risk of heart disease was unaffected. Making a decision about therapy has gotten considerably easier.
If hot flashes, insomnia, vaginal dryness, or other symptoms are making you miserable, HRT is a good choice provided you don't have a history of breast cancer, heart disease, or blood clots.
Women with milder symptoms may want to try other options before HRT. Some have found relief through working out regularly; avoiding alcohol, caffeine, and spicy foods; using water-based vaginal lubricants; and regularly doing Kegel exercises. Low-dose antidepressants such as Prozac or Celexa can moderately reduce hot flashes and improve mood.
Doctors should work with women to find the lowest effective dose of HRT. Studies show that many women respond to much lower doses than have been typically prescribed. Some pharmacists will make customized "bioidentical" or "natural" hormones, tailoring the dose to the individual, but there's no scientific evidence that these are safer or more beneficial than traditional therapies.
HRT remains the most effective treatment for severe menopause symptoms, says Warren: "It's a shame to think women are out there suffering because they aren't getting the help they need."