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Beyond HT

Menopause is a time of transition. Biologically, it marks the time in midlife when ovarian hormones ebb, resulting in the end of your period and, often, the beginning of hot flashes, mood swings and vaginal discomfort. A few years ago, if you struggled with menopausal symptoms, the solution for managing them was relatively simple: Your doctor wrote a prescription for menopausal hormone therapy (HT). But when studies linked HT to an increased risk of breast cancer and heart disease, women began asking about other options.

Since the American College of Obstetrics and Gynecology issued guidelines in 2004 advising that short-term, low-dose HT may be suitable for certain women after all, some women have opted to begin or return to HT. Other women are sizing up the alternatives.

If you’ve decided to forgo HT, the following tips may help relieve menopausal symptoms:

Problem: Hot flashes

Hot flashes typically last from 30 seconds to several minutes. Hot flashes that occur during sleep, called night sweats, can cause you to wake up often, making it hard for you to get the rest you need.


Avoid overly warm rooms, use fans and layer clothing. Avoid triggers like alcohol, caffeine and spicy foods. Try to manage stress, which can exacerbate hot flashes, and exercise regularly.

Problem: Vaginal discomfort

Less estrogen in your body leads to drier, thinning vaginal tissues. Menopausal women often report vaginal burning and itching and can experience urinary tract infections. Pain during intimacy can also lead to a decrease in desire.


Try over-the-counter lubricants and creams to relieve vaginal dryness. Don’t turn away your spouse—staying sexually active actually helps relieve irritation. If you think you have an infection, see your doctor for prompt treatment.

Problem: Mood swings

Mood dips can greatly diminish your quality of life. Hormone changes may be partially to blame for your irritability or depression, and fatigue caused by sleep deprivation can contribute to your low moods.


Be proactive about getting a good night’s sleep—keep the room comfortably cool to fight night sweats. Exercise during the day to control stress and promote a better night’s rest, but avoid exercise within two hours of bedtime or you may struggle to fall asleep. Get support if you’re feeling overwhelmed. If you’re deeply sad or your mood doesn’t lift, ask your doctor about treatment for possible depression.

Problem: Urinary incontinence

Thinning tissues near the bladder can lead to pain during urination or an increased need to urinate. You may find yourself suddenly leaking urine.


Empty your bladder regularly to avoid leaking. Perform Kegel exercises to strengthen the muscles near your bladder and urethra: While sitting or standing, tighten the muscles of your vagina, as you would to stop urine flow, without using your stomach, leg or buttock muscles. Squeeze for 10 seconds and then relax for 10 seconds. Do this 20 times, three to four times a day. If self-help measures don’t work, ask your doctor about medical options.

Lifestyle changes

Many daily choices you make can affect your menopausal symptoms. Consider these suggestions for change:

  • Exercise. Regular exercise eases stress and fights the weight gain many women struggle with during menopause. Lifting weights, jumping rope, jogging and walking are ideal exercises to help ward off bone-density loss.
  • Eat well. Plan low-fat meals and snacks that include a variety of fruits, vegetables and whole grains. Make sure you get adequate calcium from your diet or supplements.
  • If you smoke, quit. Smoking increases hot flashes and ups your risk of cardiovascular disease, cancer and other health problems.
  • Get checkups. Your doctor can recommend ways to fight your symptoms—including herbal remedies you may try (see box at left).
  • Practice relaxation techniques. Meditation, tai chi and yoga are great stress-relievers, but don’t limit yourself to these—if knitting, reading or taking a bubble bath calms you, make time for these activities.
  • Keep a regular sleep schedule. Getting enough rest makes life more manageable. Avoid daytime naps and relax before bedtime with soothing music or a good book. Leading a healthy lifestyle can lessen or prevent unwelcome symptoms, allowing you to experience menopause as a time of positive change, with new possibilities for growth and enrichment.

Herbal remedies: Can they help?

Although no scientific studies have proved their effectiveness, some women find relief using herbal supplements. Since they can carry risks, especially when combined with other medications, talk to your doctor before trying these options:

  • Black cohosh. This North American plant may act like estrogen to relieve hot flashes, night sweats and depression—but has been linked to cases of hepatitis.
  • Chasteberry extract (also called Vitex). This is the dried ripe fruit of the chaste tree. Some women feel it reduces vaginal dryness, eases depression and increases sexual desire.
  • Soy products. Phytoestrogens (plant estrogens) in soy foods are thought to relieve hot flashes and vaginal dryness and may protect against osteoporosis, or low-bone density. Excess soy consumption may not be advised for women at risk for estrogen-related cancers.