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Menopausal hormone therapy

Menopausal hormone therapy (HT) was once thought to be the magic bullet that not only stopped osteoporosis and prevented heart disease and cancer but could also ward off any unpleasant symptom menopause would throw at you.

But that was before the Women’s Health Initiative (WHI)—a 15-year research program now in an added five-year follow-up phase—and other studies showed us how estrogen plus progestin could actually increase heart attack, stroke and breast cancer risks. Since the discovery, many women who took hormones stopped.

Experts now say they may have overestimated the risks and HT is still a safe and effective way to treat moderate to severe menopausal symptoms. If you suffer from menopausal symptoms, discuss the following questions and answers with your healthcare provider to see whether HT may be right for you:

What’s so bad about HT?

When the government-sponsored WHI analyzed long-term HT use, researchers found that women taking an estrogen-progestin combination treatment increased their heart disease, breast cancer, stroke, blood clot and dementia risks. Women taking only estrogen faced a slightly increased risk of stroke.

So, why would any woman want to take it?

HT is still one of the best ways to slow bone loss and manage menopausal symptoms such as hot flashes, night sweats, vaginal discomfort (dryness, itching, burning, painful intercourse) and mood swings. These symptoms usually lessen or stop in one to five years after menopause’s onset. Since there’s minimal risk of heart attack or stroke for most women when HT is given in low doses for short periods of time, HT’s benefits may outweigh the risks. And low-dose HT may reduce your colorectal cancer risk, too.

Can I take HT?

You need to talk with your healthcare provider to see whether you’re a candidate for HT. Women who shouldn’t take it include those who have had a heart attack or stroke, are at a high stroke or blood clot risk, have had breast cancer or a family history of it or have or are at risk for endometrial cancer.

Do I have other options?

Vaginal creams containing estrogen, antidepressants, soy products and herbal supplements may take the edge off menopausal symptoms, while other options can be used to treat or slow bone loss. The latter includes everything from bone-sparing and estrogenlike drugs to calcium and vitamin D supplements. But you can also do your part in calming menopausal symptoms. That includes eating a diet rich in fruits, vegetables and whole grains; maintaining a healthy weight with regular, weight-bearing activity; and not smoking.