Recent studies have called the safety of HRT into question in the minds of some people. Information on this issue is fundamentally incomplete, however investigating alternatives and self-care methods is always a good idea.

Women who are seeking alternatives to hormone replacement therapy (estrogen alone or estrogen plus progestogen) are advised to consider the following:

  • Discuss with your healthcare provider whether stopping therapy is appropriate. This will be determined if the potential risks for you are thought to exceed your individual potential benefits. Every woman is unique. Do not stop without speaking with your healthcare provider.
  • If you and your healthcare provider determine that therapy should be stopped, tapering off therapy is advised to lessen the chance of rebound hot flashes. Do not stop abruptly. How to taper therapy depends on the therapy you are using.
  • Estrogen is an “umbrella” therapy that treats many symptoms. When estrogen is not an option, one specific therapy must be chosen to treat each specific symptom.
  • After going off therapy, determine what menopause-related symptoms you have that are severe enough to warrant treatment. Many women need no treatment at all, as some of these symptoms will stop on their own without treatment over time. The most common symptoms are hot flashes, difficulty sleeping, and vaginal dryness. Below are suggested treatments.

Hot Flashes

  • First, try lifestyle changes. Avoid getting too warm by dressing in layers and sleeping in a cool room. Avoid getting too warm inside, too, by not drinking hot beverages and eating hot soups. Avoid hot flash triggers, such as drinking alcohol and eating spicy foods. Reduce stress. If you feel a hot flash coming on, take slow, deep breaths and the hot flash may be lessened or avoided altogether.
  • If more help is needed, some research suggests that mild hot flashes can be relieved by consuming a serving of soy foods daily or taking a supplement of black cohosh. Effects, if any, may take a few weeks.
  • If more help is needed, several prescription drugs that are FDA-approved for other uses have been found to help some women with hot flashes: the antidepressants Effexor, Prozac, and Paxil, and the cardiovascular drug Catapres.
  • Acupuncture has been shown to be beneficial in the treatment of hot flashes and other menopausal symptoms.

Difficulty Sleeping

  • With hot flashes treated, sleep quality should improve.
  • Acupuncture can be very effective in the treatment of insomnia.

Vaginal Dryness

  • Vaginal lubricants and moisturizers available over the counter can help lubricate the vagina and ease intercourse.
  • Severe cases of vaginal dryness respond only to prescription estrogen. Prescription estrogen products are available that are specifically for the inside of the vagina. They are not absorbed to a great extent into the circulation. These include vaginal estrogen creams, a vaginal estrogen tablet, and a vaginal estrogen plastic ring. Estrogen used this way will not help with hot flashes or any other condition, but it is not associated with any side effect.

Reduce Risk for Osteoporosis

  • After menopause, a woman’s risk of osteoporosis (thin bones) increases, making it more likely to sustain a fracture. Talk to your healthcare provider about determining the strength of your bones, perhaps by getting a bone scan. A complete discussion of other risk factors is also recommended.
  • If you are not at risk, it’s still a good idea to make sure you get adequate calcium and vitamin D. Getting appropriate exercise is also recommended.
  • If you are at risk or have osteoporosis, you need calcium and vitamin D plus a bone drug. There are many well-proven prescription therapies from which to choose.

Reduce Risk for Heart Disease

  • After menopause, a woman’s risk of heart disease also increases. Talk to your healthcare provider about your risk. A test of your blood for cholesterol is also recommended.
  • If your blood pressure is high, or your cholesterol is not healthy, there are several well-proven prescription therapies from which to choose.
  • If you have diabetes, make sure you control your blood sugar, as risk for heart disease is increased when you don’t.

General Advice

Finally, the following general health-promoting habits are recommended:

  • Don’t smoke
  • Eat a healthy diet
  • Maintain a healthy weight
  • Get adequate exercise
  • Reduce stress

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