Facing Menopause and Its Symptoms

As you approach menopause (or are propelled into it) your most immediate concern is usually the "in-your-face" symptoms: hot flashes, weight gain, vaginal dryness, mood swings, loss of energy, and skin and hair changes. Long-range issues include osteoporosis, heart and vascular disease, and how to live a full and reasonably happy life.

You may have only a few menopausal symptoms, or you may have every one in the book. Under normal circumstances, you should not feel rushed to make decisions to cope with these symptoms. But if they began because of a medical, surgical, or "cold turkey" menopause, and if a particular symptom stands in the way of your normal activities, you may be eager to get help.

The recommendations that follow include a range of suggestions covering lifestyle choices, complementary therapy, and conventional medicine. Most effective therapies have some side effects, but potential benefits should clearly outweigh them.

Start with the simplest, mildest remedy with the broadest benefit and the least number of side effects, then gradually move on to stronger forms or amounts of treatment. Careful exercise is an ideal example of a therapeutic measure with minimal drawbacks: It strengthens your bones and heart, controls weight, lessens hot flashes, improves your sleep, boosts your energy, revs up your sex drive, and makes your skin glow — without side effects.

At the potent but risky end of the treatment spectrum is hormone replacement therapy (HRT). While HRT can ease menopausal symptoms, current and past users of HRT have a higher risk of being diagnosed with breast cancer. Before the link between HRT use and breast cancer risk was established, many post-menopausal women took HRT for many years to ease menopausal symptoms and to reduce bone loss. Since 2002, when research linked HRT and risk, the number of women taking HRT has dropped dramatically. Still, many women continue to use HRT to handle bothersome menopausal symptoms.

If you've been diagnosed with breast cancer or have tested positive for an abnormal breast cancer gene (BRCA1 or BRCA2) and so are at high risk, you shouldn't use HRT. The hormones in HRT can cause hormone-receptor-positive breast cancers to develop and grow. While only a few small studies have looked at HRT use in women with a personal history of breast cancer, the fact that HRT use increases breast cancer risk among women in general makes almost all doctors advise women with a personal history of breast cancer to avoid HRT. The prescribing sheet included with HRT clearly states that it is "contraindicated in women with a diagnosis of breast cancer." Not being able to use HRT can present a challenge for many women. If you're having severe hot flashes or other menopausal side effects and have a personal history of breast cancer, talk to your doctor about non-hormonal options, such as dietary changes, exercise, weight management, acupuncture, or meditation.

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