For years, hormone replacement therapy, or HRT, was the most common treatment for menopausal symptoms such as hot flashes and decreased libido. Many women were also given HRT to reduce their risk of heart disease and osteoporosis. However, in 2002 and again in 2004, a major study called the Women's Health Initiative (WHI) revealed that the risks of HRT, including a slightly higher risk of breast cancer, heart attack, stroke, and blood clots, greatly outweighed its benefits. However, HRT is still the best way to treat hot flashes and osteoporosis; you (and your doctor) must weigh the risks and benefits according to your own symptoms and situation.

Two separate portions of the study found HRT carried significant risks. The 2002 portion of the study focused on women with a uterus who took Prempro, a combination estrogen and progestin medication: it showed the women had a 26 percent increase in breast cancer, a 41 percent increase in strokes, and a 29 percent increase in heart attacks. The second portion of the same study focused on women without a uterus who were taking Premarin, an estrogen-only medication. It found that estrogen replacement increased stroke. Both portions of the study were stopped early when it became clear that the risks outweighed the benefits.

A third study, known as the Heart Estrogen/Progestin Replacement Study (or HERS), published earlier in 2002, found HRT had no benefit on the heart.

What Does This Mean for You?

The HRT studies, while dramatic, should not preclude all women from taking HRT for their menopause symptoms. For one, HRT has proven short-term benefits for menopause. Second, the increased risk found in the studies still translates into small numbers: 8 out of 10,000 women on estrogen-progestin HRT will develop invasive breast cancer and 7 will have a heart attack. In addition, age may affect risk for some diseases. The WHI study suggests that risk for heart disease from HRT is lower if a woman takes it earlier. Women aged fifty to fifty-nine who took estrogen have fewer heart attacks and deaths from coronary heart disease than women who took a placebo. Finally, low-dose HRT may provide as much relief as higher doses.

Using HRT skin patches or an estrogen cream are other ways to modify treatment and manage risk. For example, if you are taking HRT for vaginal dryness, you may be better off with a localized estrogen cream. Similarly, if you're using HRT to increase your libido, skin patches may be a better choice than oral medications, since a report presented at the World Congress on Menopause in 2002 found that skin patches can help women achieve orgasm better because they don't have to first pass through the liver, as oral medications do.

Experts generally recommend HRT be taken in the lowest dose for no longer than two to four years.

One caveat, HRT may sensitize your body to the hormones. If you take HRT to relieve symptoms such as hot flashes, your symptoms may actually worsen if you discontinue the medications.

Other Treatments

There are alternatives to HRT. Mood symptoms, for example, can be managed with antidepressants such as Prozac or Paxil. Blood pressure and epilepsy medications may also help.

Other physical symptoms can be treated with lifestyle changes, diet, alternative medications, and over-the-counter medications. In terms of diet, avoid spicy foods, alcohol, and caffeine to minimize hot flashes, flushing and anxiety, or irritability. Incorporating soy into the diet eases symptoms related to estrogen-loss.

Physically, you'll want to dress for rapid body temperature changes by wearing layers and light clothing, exercise three to four times a week (muscle strengthening and flexibility exercises are especially good), and quit smoking.

Relaxation techniques such as yoga or meditation can also help you manage symptoms, especially hot flashes, which can come out of the blue. Acupuncture may improve symptoms, and herbal supplements such as black cohosh may also help reduce symptoms since they contain substances called phytoestrogens that are similar to estrogen. Also some women find relief with vitamin E, although there is no clinical proof that it helps.

Finally, try over-the-counter medications such as lubricants to ease vaginal dryness and increase enjoyment during intercourse.