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The Best Possible Menopause


Now that recent research has indicated that hormone replacement therapy (HRT) can increase the risk of breast cancer and heart disease, more and more women are looking for alternative treatments. In fact, a lot of women have been wondering all along whether HRT was the best solution to the menopause puzzle. They reasoned that menopause was a natural process. Why take medication?

As with so many issues regarding health, the way to give yourself a good chance at a menopause that’s fairly easy to manage is to live a healthy lifestyle. There are also some “alternative” treatments to hormones that you might want to talk about with your doctor. 

Managing the short-term symptoms

Hot flashes: Some practical things might work first.

  • Keep your bedroom cool when you’re sleeping.
  • Dress in layers so you can easily remove some clothing when you feel a hot flash coming on.
  • Try avoiding alcohol and spicy foods and see if that helps.
  • See whether getting a little soy (tofu, tempeh) and flaxseed in your diet each day helps relieve your symptoms.
  • You may also want to take a supplement of black cohosh. Small studies in Germany have shown that it can be effective, and larger studies are currently underway at the National Institutes of Health.

Difficulty sleeping: For the most part, the difficulty sleeping happens because of hot flashes. If you get the hot flashes under control, your sleep should improve.

Vaginal dryness: You can treat this with estrogen lubricants, creams and gels and with a vaginal ring. These products are thought to be safe because they generally don’t enter the blood stream.

Mood swings: It’s probably difficult to eliminate mood swings altogether, but there are things you can do to help. Make an effort to get regular exercise almost every day. This can help to regulate mood and metabolism. You may also want to investigate relaxation techniques, such as deep breathing, meditation, qigong, etc. 

What about so-called “natural” hormones?
The HRT combination that the vast majority of women have been using is made from estrogen that’s extracted from the urine of pregnant horses. This is the estrogen used in the two studies that produced results indicating that HRT can increase the risk of cancer and heart disease.

There are other forms of estrogen available. They’re produced in laboratories, but they contain the same types of molecules found in the estrogen that a woman’s own body makes. These are called “bio-identical” estrogens. Estradiol is the most commonly used one. Some women think it makes sense that these hormones are safer because they’re more like the ones in their own bodies. But nobody knows for sure whether this is true. There haven’t been any large-scale studies done on these bio-identical estrogens, so it’s impossible to say for sure whether they carry any risk. If you’re interested in investigating them, be sure to talk with your doctor.

What about the longer-term symptoms?
For the long-term implications of menopause—heart disease and bone fractures due to osteoporosis—it’s important to talk your doctor, assess your health status and determine a non-HRT treatment plan for your specific symptoms. For osteoporosis, this could include making sure you get enough calcium (1,500 milligrams a day for post-menopausal women) by taking supplements, taking medication to prevent bone loss and getting regular, weight-bearing exercise. For heart disease, you should manage your cholesterol and triglyceride levels through diet, exercise and medication if necessary.

The longevity factor
One theory is that since menopause is a natural part of aging, you shouldn’t have to treat it at all. There’s some logic there, but don’t forget that women are living longer than ever before. Even a century ago, many fewer women lived into their 70s, 80s or 90s. That meant fewer fractures and fewer cases of heart disease. So there’s something to the idea of taking medication to reduce the severity of the common problems of aging. But all we can say for sure now is that the HRT combination that many women have been taking has not been shown to be safe for the long term. The jury’s still out on the other options.

It’s basically up to you and your doctor to consider all the information that’s available and then to make a decision that you feel comfortable with.

American College of Obstetrics and Gynecology; Journal of the American Medical Association, 17 July 2002; The New York Times, 23 June 2002; The North American Menopause Society
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