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Menopause symptoms: Surviving the change

​​​It's a bit of a conundrum. Prolonged annoying menopause symptoms may cause health problems, but research has shown that hormone replacement therapy (HRT) to relieve symptoms may have potential health risks.

What is right for you? Talk with your doctor to make the best choice.

Menopause symptoms usually begin around age 50 to 55 and may include hot flashes, anxiety, trouble sleeping, night sweats, vaginal dryness and painful intercourse.

"It's hormonal," said Family Medicine Physician Namrata Mehta, M.D.​, Marshfield Clinic Marshfield Center. "Some women aren't bothered by the symptoms. For those who are, it's a good idea to talk with your doctor to learn about treatment options."

Menopause can occur naturally with the ending of the menstrual cycle or if the ovaries are removed during surgery for medical reasons.

"Previously doctors would prescribe HRT for every woman experiencing menopause symptoms in an effort to also protect her from heart disease," Dr. Mehta said. "Research has changed that thinking and the thinking is still evolving. If you are age 50 to 59, depending on your medical history, your doctor may recommend HRT to help manage menopause symptoms only."

Estrogen is the hormone being replaced with HRT. It is the same estrogen taken in birth control pills except at a lower strength. Taking estrogen does increase the risk for blood clots. HRT is not recommended for women who have a family or medical history that includes risk for heart disease, stroke or breast cancer.

"Because the strength of estrogen in HRT is much less than in birth control pills, the risk for blood clots with HRT is quite low," said Dr. Mehta. "For thin, healthy women, it is very minimal."

A thorough discussion of your medical history with your doctor is a good first step, Dr. Mehta said. Vascular disease, diabetes, past blood clots, high cholesterol, high blood pressure and high blood sugars also are indicators not to prescribe HRT.

"I weigh the risk and benefits of any medication or HRT," Dr. Mehta said. "When your medical history warrants, or if you are concerned about risk factors, safe alternatives to HRT are available for symptom relief." 

Depression and anxiety also are common symptoms women experience during menopause. These conditions can be quite detrimental to a woman's daily life, causing problems such as panic attacks.

A short-term, monitored antidepressant medication can dramatically improve these symptoms and improve quality of life, Dr. Mehta said.

"I had a patient come to me who said she couldn't function because of overwhelming anxiety during menopause," Dr. Mehta said. "Once we diagnosed the cause, we were able to treat her with a safe antidepressant medication. It helped her through a very difficult period in her life, and she only needed it short term."