Is it warm in here? If you’re menopausal, it sure can feel that way. Hot flashes and night sweats are among the most troublesome effects of the major hormonal shifts that occur during menopause, and women for generations have tried to rid themselves of these annoying episodes.

For a while, we thought we had the answer: Hormone replacement therapy (HRT) quenched the internal fire and was promoted as a general boon to women’s health, helping maintain bone density and cardiovascular health. Then, in 2004, the Women’s Health Initiative brought all the good news to a screeching halt.

The WHI study indicated that, instead of protecting women’s health, HRT actually increased risk of heart disease and breast cancer. Women were back at square one, sweating through menopause without much relief.

Current thinking in the medical community generally calls for caution and a careful analysis of individual patients’ symptoms and other risk factors. HRT is back, but with a more limited scope.

“There’s a place for hormone replacement therapy, but it’s a smaller piece of the pie,” says Dr. Denise Meckler, a physician with OB-GYN Associates Inc. and on staff at Missouri Baptist Medical Center. “It’s for a select grouping of people who are very symptomatic and have minimal risk factors. And then we only use it for a very short period of time—between five and 10 years, where we used to use it for 20, 25, 30 years.”

Meckler’s approach is fairly standard these days. The American College of Obstetricians and Gynecologists states: “If you currently have or have a history of DVT (deep vein thrombosis) or blood clots in the lungs, have active or recent cardiovascular disease (such as a stroke or heart attack), have estrogen-related cancer (such as breast cancer), have liver disease, or have undiagnosed uterine bleeding, you should not take hormone therapy. If you are healthy, it is recommended that you use the lowest effective dose for the shortest amount of time possible. Continued use should be re-evaluated on a yearly basis.”

However, there is not unanimous agreement about the use of HRT. “When we’ve looked at the data, most of the studies do not show the big scare that everybody saw back in 2004,” says Dr. Michael Thomure, a SLUCare obstetrician and gynecologist. He notes that the original WHI study involved subjects who were much older than the typical patient seeking relief of menopausal symptoms, a difference that could have significantly skewed results. “We don’t ever start hormone replacement therapy at the age of 63. The earlier you start, the better. If you start later in life, you could run into problems.”

Meckler adds that there are other treatments that may help women better weather menopause. “There are some natural remedies such as black cohosh for hot flashes. For poor sleep, you can use a sleeping agent such as melatonin or Ambien. For mood swings, we suggest antidepressants or St. John’s wort, which is like a natural form of Prozac.” Exercise, meditation and stress management also may be helpful. “There’s no need to be miserable—there are things that can be done.”

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