Questions to Ask Your Doctor About Hormone Therapy During Menopause

1. What is hormone replacement therapy?

The term "hormone replacement therapy" or HRT, refers to the hormones estrogen and/or progesterone that are taken regularly to stabilize and increase a menopausal woman's hormone levels. It's good to know all the options that are available, from pills to patches, creams, and vaginal rings. Your doctor can explain them.

2. Why do some women need hormone replacement therapy during menopause?

Hormone therapy helps women whose menopausal symptoms -- hot flashes, night sweats, insomnia, mood swings, vaginal dryness -- are severe and affecting their quality of life.

For some women, these symptoms go on for years or decades after they've stopped their periods -- into the time called postmenopause.

3. What else can I do to ease menopause symptoms?

There are many things you can do to curb hot flashes, night sweats, insomnia, vaginal dryness, and lost libido.

• Dress in layers so you can take off clothes as needed.
• Avoid hot and spicy foods and drinks.
• Use cotton sheets, and wear clothes that allow your skin to breathe.
• Keep a regular sleep schedule.
• Limit caffeine and alcohol.
• Eat a healthy diet.
• Use relaxation techniques such as yoga.
• Don’t smoke.
• Get regular exercise.
• Stay active to avoid depression and seek social support from women like you.

Stay active to avoid depression and seek social support from women like you.

Lubricants can greatly ease vaginal dryness and heighten sexual sensation.

Your doctor can give you more information about these techniques and other treatment options. The use of selective serotonin reuptake inhibitors (SSRIs, a form of antidepressant) has become more common in women who are not good candidates for hormone therapy or prefer not to use hormones. Paroxetine (Brisdelle) is the only nonhormonal therapy specifically approved by the FDA for hot flashes, but some relief has been found with gabapentin (Neurontin).

4. Do alternative remedies (like soy and black cohosh) help with menopause symptoms?

Studies into natural treatments for menopause symptoms have had mixed results. Some have shown that soy helps with hot flashes and night sweats but might be dangerous for women at risk for hormone-related cancers of the breast, ovaries, and uterus. Black cohosh may help some women control hot flashes, night sweats, mood swings, and insomnia -- but again, research has been mixed, and some reports have linked black cohosh to liver problems.

Other natural remedies include chasteberry, red clover, dong quai, kava, and evening primrose oil. Your doctor can help you decide whether any alternative treatments are right for you.

5. Is it time for me to try hormone therapy?

Several things play into whether hormone replacement therapy is the best option for you. Your age is one of them. Your doctor will also want to consider whether you’ve had a hysterectomy and whether you have certain health risks, such as a family or personal history of breast cancer or clotting disorders.

6. What are the risks of hormone therapy?

Hormone therapy is not risk-free. In some women, hormone therapy can increase the risk of breast cancer, stroke, and blood clots. It’s important to weigh the risks against the benefits by talking to your doctor.

7. What are the benefits of hormone therapy?

The estrogen in hormone therapy can greatly relieve menopause symptoms such as hot flashes and vaginal dryness. It can also lower a woman’s risk of colon cancer and macular degeneration (vision loss that occurs with age), and help protect bone strength.

8. How long will I have to take hormone replacement therapy?

Most women take hormone therapy for the shortest time possible -- and at the lowest dose. There is evidence that serious health risks such as blood clots, breast cancer, and stroke increase after 5 years of use. If you have personal or family history of these and other health risks, this will affect your decision regarding hormone replacement therapy.

9. Will hot flashes and other menopausal symptoms return when I quit hormone therapy?

Your symptoms may return slightly when you stop taking hormones, but they will likely taper off over several months to a year. Your doctor can help you manage these symptoms. For some they may be lifelong.

10. Are there other things I can do to protect myself against osteoporosis?

Doctors have long known that estrogen therapy helps prevent osteoporosis (but hormones should not be given just to prevent or treat osteoporosis). There are many other ways to protect your bone health. Regular weight-bearing exercise and a diet high in calcium and vitamin D strengthen bones. There are also many bone- building medications available to women today. Your doctor can help you decide the best bone health strategy for you.

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