What are the Options?

Just as each of us is unique and complex, so the menopause experience and the hormonal transition it involves are different for each of us. Some women may want to consider judicious hormone replacement therapy (HRT), which can consist of either natural or synthetic drugs. Others may opt to use herbs, which when used wisely have few, if any, of the side effects of drugs, and can often produce the same beneficial results as drugs. The years of menopausal change signal the end of one chapter and the beginning of another. The general concepts of health—eating a nutritious diet, getting sufficient exercise and changing our lifestyle—are especially appropriate during menopause.

Whether you choose conventional hormone replacement therapy or alternatives, or a combination of both, ProjectAWARE believes it is important for each woman to be proactive in understanding all the choices and in considering the available therapies for her personal journey. There is no single strategy for success.

Science defines menopause as a "problem" resulting from lack of estrogen. However, for the majority of women, good menopausal health is not as simple as replacing lost estrogen. Indeed some women cannot, or choose not, to take hormone replacement therapy (HRT). Estrogen replacement therapy (ERT) and HRT may relieve hot flashes and other menopausal symptoms, with possible protection against osteoporosis, heart disease and stroke, but hormone therapies do present possible risks. Using estrogen supplementation, for instance, is not advisable for women at high risk of breast or uterine cancer, fibroid tumors, liver or gall bladder disease, or depression. It is now a well-established fact that supplementing with only estrogen (ERT) is associated with an increase in endometrial cancer. To weaken the link between estrogen and endometrial cancer, drug companies and physicians began to recommend that estrogen be combined with a progestogen (synthetic progestin or natural progesterone). Although a combination of estrogen and progestogens appears to have reduced the risk, each woman and her doctor must decide which combination is best.

Women concerned about using synthetic drugs whose molecules are not identical to the human hormone molecule, may opt for natural hormones which are created in the laboratory as bio-identical to the body's own hormones. Often referred to as NHRT (natural hormone replacement therapy), these hormones include natural progesterone, 17 beta estradiol, DHEA, pregnenolone, and natural testosterone. Even women using natural hormones are advised to do so under the care of a qualified practitioner, who can prescribe individualized formulations by a compounding pharmacy.

For women who want neither natural nor synthetic hormone replacements, one alternative approach is herbs. When used wisely, herbs have few, if any, of the side effects of drugs. By offering remedies that aid the menopausal process rather than attempting to stop it, herbs help us keep in touch with the natural process of menopause. Just as all foods have the potential for causing distress in some people, herbs are no exception and should be used with care.

There is no doubt that nutrition plays an instrumental role in general health, so it's not surprising to find that it plays a very important role in menopausal health. Women who are too thin have lower estrogen levels and tend to be at higher risk for such menopause problems as osteoporosis and hot flashes. Dr. Andrew Weil, in his book "Eating Well for Optimum Health," reminds us that an optimal diet can both supply the basic needs of the body and strengthen the body's defenses and healing mechanisms. He candidly admits that doctors have little or no formal education about nutrition in the course of their studies, so it's up to us to learn all we can.

Always important, exercise is especially beneficial for women in their menopausal years. Aging is often hastened by physical inactivity. In 15 years' experience working with thousands of women in their menopausal years, Susan Lark, MD found exercise helps "relieve and prevent many symptoms of menopause such as hot flashes and night sweats, thinning and irritation of the vagina and urinary tract, depression, insomnia, osteoporosis and elevated cardiovascular risk factors."

We may experience many rewards if we pay attention to nourishing and tonifying our entire hormonal system and restoring depleted energy through meditation or energy therapies. Learning to handle anger, depression and stress will ensure a smoother passage through menopause. While it is nice to receive outside emotional support, there are things we can do to boost our own self-confidence and contentment. Repeating affirmations and creating a nurturing lifestyle help restore self-love and acceptance.

For more information about managing your menopause, see these topics on Project AWARE:

• Managing Menopause
• Hormone Replacement Therapy (HRT)
• Alternatives to HRT
• Exercise for Menopause
• Lifestyle Changes for Menopause

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Updated  09/01/2008