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JoAnn Manson, MD, author of Hot Flashes, Hormones, and Your Health, suggests asking yourself three questions before going to the doctor.
Amid all the recent confusion about hormone therapy (HT), it is still an appropriate option for some women. Although it's been proven as a treatment only for hot flashes, night sweats, and vaginal dryness, it may also improve sleep, mood, and concentration.
But like most medications, HT carries risks, including higher rates of stroke, blood clots in the legs and lungs (perhaps less of a problem with patches or gels than pills), breast cancer (especially with combination estrogen and progestin), and, for older women, heart disease. So it's worth trying other options first—layered clothing, portable fans, exercise, relaxation techniques, and avoiding dietary triggers such as alcohol, caffeine, and spicy foods. And although research findings are decidedly mixed, some women report hot flash relief from soy, black cohosh, and certain antidepressants.
If, however, none of these strategies work, and you want to consider HT in consultation with your doctor, ask yourself:
1. Do I have hot flashes or night sweats that disrupt my sleep or quality of life?
If the answer is yes, HT may be a good option for you, especially if you have recently entered menopause. If, however, vaginal dryness is your sole complaint, try low-dose topical or vaginal estrogen products, which do not have the same systemic absorption as pills or patches and can be used safely for longer. If you're concerned about bone health, be sure to get adequate calcium, vitamin D, and weight-bearing exercise, and ask your doctor about the nonestrogen medications available for preventing osteoporosis.
2. Does my health profile make hormone therapy too risky?
Any woman who has a history—or high risk—of breast, uterine, or ovarian cancer should avoid hormone therapy. The same is true for those with liver or gallbladder disease or unexplained vaginal bleeding. And if you're more than ten years past menopause or have an elevated risk of heart disease or stroke, HT is not a good choice for you either. If none of these health issues applies to you, then you may be a good candidate for HT.
3. Am I comfortable with the idea of using hormone therapy?
If—and only if—your symptoms and health profile suggest that hormone therapy is appropriate, you'll need to rely on your own information gathering and instincts to make the decision. Despite society's tendency to "medicalize" menopause, keep in mind that it is not an "estrogen-deficiency disease" but rather a natural stage of life. Interestingly, we no longer refer to hormone therapy as HRT, because the R stood for "replacement"—when, in fact, there is nothing missing. (Premature menopause due to surgery or ovarian failure is different: In these cases, HT is treating a medical condition.) If you are hesitant to take hormones for any reason, you should firmly resist pressure from your doctor, partner, or peers to do so.
On the other hand, if you decide to try HT (and have no risk factors), keep in mind that it is best taken for only two to three years and, as a general rule, no more than five.
From the February 2009 issue of O, The Oprah Magazine
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