Health Watch

Adaptation to menopause

In order to relieve symptoms of menopause, as well as to reduce specific health risks in menopausal and postmenopausal women, physicians often prescribe the synthetic hormones estrogen, progestin (a synthetic form of progesterone), and sometimes androgens. This therapeutic approach is called hormone replacement therapy (HRT). Administered as oral tablets, skin patches, or vaginal creams or suppositories, HRT alleviates symptoms of menopause and may increase verbal memory. It also may counteract some serious health problems associated with menopausal women. For instance, osteoporosis, in which bones become brittle and vulnerable to fractures, is caused by calcium loss. Calcium loss accelerates in women for three to seven years after menopause. The use of HRT combats bone calcium loss and significantly lessens the risk of osteoporosis.

Women who have had a hysterectomy can use estrogen replacement alone, but women with a uterus need the addition of progestin to prevent hyperplasia (overgrowth) of the endometrium (uterine lining) and decrease the risk of endometrial cancer. Androgens may help women with decreased sexual interest.

Hormone replacement therapy may be taken continuously or cyclically (usually three weeks on and one week off). Symptoms may return each month during the hormone-free week. HRT may be associated with an increased risk of breast cancer, heart attacks, strokes, and blood clots, and studies of the long-term use of HRT so far make it unclear if the benefits of HRT outweigh these risks. Each woman and her health-care provider should assess her need for symptom control and the potential risks and benefits before starting HRT. Women who have a history of endometrial cancer, breast cancer, stroke, blood-clotting disorders, liver dysfunction, and undiagnosed abnormal vaginal bleeding should generally not take HRT. More research is needed on the long-term effects of the various HRT regimes.

Other ways of reducing negative effects of menopause include eating a healthy diet, eliminating caffeine and alcohol, reducing sugar and salt intake, stopping smoking, and taking vitamin supplements. Exercise helps increase conversion of androgens to estrogens and can help alleviate menopausal symptoms.

How women view menopause may also affect symptoms. Traditionally in our culture, menopause has been viewed negatively, as a period of fluctuating hormones that incapacitates women. In fact, many women experience only minor discomfort during menopause, and some find renewed energy and enthusiasm after menopause.

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