- Drugs:
Since menopause results from a lack of estrogen, the "gold standard"
of treatment has traditionally been estrogen replacement therapy (ERT) or hormone
replacement therapy (HRT). This can come in the form of a pill, patch, vaginal
creams, vaginal rings, or long-acting injections. Estrogen alone may increase
the risk of endometrial hyperplasia which can lead to endometrial cancer (cancer
of the lining of the womb), however, so most women will also take a progestin;
this can be give daily or in cyclical dosing patterns (which will give a woman
light periods again). Some preparations combine the estrogen and progesterone
in one pill or one patch. Women who have had a hysterectomy (surgical removal
of the uterus) do not need to take a progestin. Because there are many formulations
of estrogens and progestins, there are many different products, from many different
manufacturers. While they generally act in the same manner, each product does
have a different side effect profile. Therefore, women who have annoying side
effects on one product can often be changed to another product with different
results. Never stop taking your medicine without discussing it with your physician.
Many women do not want to take medicine for many years in order to prevent
symptoms or illnesses that they don't know that they will, in fact develop.
That is your choice. I recommend that it be an informed choice, however. Speak
with your physician and read as much as you can from credible sources. You
don't go into menopause in one day; don't expect to prepare for
it in one day. I do caution you against making a decision based upon misinformation.
Despite the more than 3,000 published papers in the medical literature over
the past 50 years studying or reviewing estrogen's use, hormone replacement
therapy (HRT) continues to be surrounded by waves of controversy and confusion.
Recent news from the Women's Health Initiative (WHI--July 2002), has more
clearly identified some of the risks of long-term therapy (more than 5 years)
with combination HRT. Because of an increased risk of invasive breast cancer,
heart attacks, strokes, and blood clots in the women taking combination HRT
compared with women taking placebo, this arm of the study was prematurely
canceled. The most important findings of the WHI Study comparing the estrogen
plus progestin group compared to placebo include:
- A 41 percent increase in strokes
- A 29 percent increase in heart attacks
- A doubling of rates of venous thromboembolism (blood clots)
- A 22 percent increase in total cardiovascular disease
- A 26 percent increase in breast cancer
- A 37 percent reduction in cases of colorectal cancer
- A one-third reduction in hip fracture rates
- A 24 percent reduction in total fractures
- No difference in total mortality (of all causes) between the groups
Note that these data did NOT apply to the group of women taking only estrogen.
For a more complete discussion of this study's results, click here.
Stress management techniques are high on the list of menopausal management strategies. Lifestyle modifications can also help- get enough rest, exercise, and eat healthfully. 
