Menopause: What is right for you?
- How to Decide What You Should Do for Perimenopausal Symptoms
- How to Decide What You Should Do to Manage Conditions of Menopause
How to Decide What You Should Do for Perimenopausal Symptoms
Treatment for perimenopausal symptoms is short-term (usually less than 5 years). We would hope that shorter use of hormones confers less risk, but studies have not adequately settled this issue. The WHI study found increasing risk of adverse outcomes beginning in the first year of HRT use, but note that the women in the WHI study were already in menopause. So what should you do?
- Assess your symptoms and how much they bother you: hot flashes, insomnia, mood swings, vaginal dryness, change in libido, urinary stress incontinence, "fuzzy" thinking.
- Assess your values regarding Western and complementary medicine, your patience with symptoms that may ease in the future without intervention, and your willingness to take hormones or other prescription medications or herbal remedies, based on the known risks, benefits and uncertainties.
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How to Decide What You Should Do to Manage Conditions of Menopause
Recent studies contradict earlier theories that HRT prevents heart disease, so a history of heart disease or risk factors for heart disease should not encourage you to take HRT. If you have been taking HRT for "heart protection," please discuss with your doctor whether or not to continue HRT.
1. Assess your risk factors for the major conditions associated with menopause and aging.
A principal benefit of HRT continues to be osteoporosis prevention, and a key risk is breast cancer so you should balance your personal risk factors for these two conditions, especially if you are considering taking HRT (see table below). Medications to prevent osteoporosis should be considered lifelong. Therefore, concerns about long-term risks of HRT are greater. You want to be sure that you are at increased risk for osteoporosis before you consider taking medications.
RISK FACTORS FOR OSTEOPOROSIS | RISK FACTORS FOR BREAST CANCER |
Family history of osteoporosis Advanced age | Personal history of breast cancer Breast cancer in mother, sister or daughter |
Fracture after age 50 | First period before age 13 |
Height loss of more than 1 inch | First pregnancy completed after age 30 |
Caucasian Underweight | Menopause after age 50 Overweight |
Menopause before age 45 | History of chest radiation or many chest X-rays |
Various antiseizure medications (e.g. Dilantin) | No full-term pregnancies |
Absence of periods from athletics | High dose birth control pill use > 10 years |
Rare exercise | Rare exercise |
Lifetime dieting or anorexia Smoking | |
Thyroid hormone replacement in high doses | |
Long-term steroid medication (e.g. prednisone ) |
2. Consider whether you have medical conditions that would increase the risk of side effects or harm from certain medicines. For example, Fosamax® can cause or worsen esophagitis; and estrogen can cause or worsen liver or gall bladder disease, blood clots, endometriosis or migraine.
3. Assess your personal values.
- Although all the conditions associated with menopause and aging merit attention, your own feelings and priorities about each one may differ. Which ones concern you most?
- What are your feelings about taking medications over the long term?
- Are you willing to undergo surveillance tests required while on medications (e.g. mammography, bone density study, possible endometrial biopsy)?
- What can you do to maximize your lifestyle? Can you take vitamin and mineral supplements regularly, eat healthy foods, exercise regularly, limit alcohol intake, avoid smoking?
4. Finally (and initially), talk with your doctor about your risks, concerns and choices.
Remember that no decision is irreversible. All choices about whether to treat and which treatments to use should be revisited regularly. Reconsider your decision in light of your own changing risks, your response to treatment or lack of treatment, new medications and new research findings.
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