We tell our patients to think about it this way: If your menopausal symptoms are severe, HT is one option that can help, but there are others. If you take HT, you need to estimate the risks and decide whether you’re willing to accept them. Only you can gauge the value of relieving your symptoms, but your doctor can help you sift through the risks.
HT remains the most effective treatment for hot flashes and vaginal dryness, two of the most disruptive menopausal symptoms. But HT doesn’t always do the trick, and sometimes it causes more symptoms (vaginal discharge, uterine bleeding, breast discomfort) than it relieves. Other remedies are less effective than HT, but they carry fewer risks. Neurontin (an epilepsy treatment) and certain antidepressants and blood- pressure medications can help relieve hot flashes and night sweats. Lifestyle approaches are worth a try. Exercise and relaxation techniques can help control hot flashes. Many women get relief by avoiding caffeine and spicy foods.
Does HT make sense for you? Chart 1 summarizes the known risks and benefits. For an average woman, combined HT lowers the risk of osteoporosis and colorectal cancer while increasing the risk of breast cancer, blood clots, heart disease and stroke. (Stroke is the main hazard of estrogen alone.) But you are almost surely not the “average woman.” If age, family history or lifestyle makes you especially vulnerable to breast cancer or cardiovascular disease, then HT will carry higher-than-average risks. HT will pose fewer hazards if you start out at low risk for these conditions.
Whether your own risk is high or low, it makes sense to try life-style and nonhormonal strategies first. They’re safer than HT, and many women find them effective. If those approaches don’t work, and you want to consider HT, the accompanying table will help you gauge the risks.
If you start HT, take the lowest effective dose for the shortest possible time. Half the standard dose is often enough. If you experience substantial improvement on HT, stick with the regimen for six to 12 months, then gradually taper off (chart 3). If your symptoms return with a vengeance, try an additional six to 12 months of treatment. But if they return in a milder form, try managing them with lifestyle changes or nonhormonal medications. If vaginal dryness is your primary complaint, an estrogen cream or ring may relieve it safely.
If your symptoms persist after two years of hormone therapy, you should carefully re-evaluate the risks, for they increase over time. Only you can decide whether they’re worth taking.
