s hormone replacement therapy (HRT) for you? The choice needs to be based on many factors and is not always an easy one.

The last in a cycle of biologic changes, menopause usually occurs around the age of 51. Symptoms can start as early as age 35 but generally start 3 to 4 years prior to menopause.

Perimenopause is the period prior to actual menopause when hormone levels begin to fluctuate. About 75% of all women experience discomfiting symptoms during this time. These can include hot flashes, night sweats, sleep disturbances, inability to concentrate, depression, nervousness and weight gain.

HRT is used to replace estrogen and/or progesterone to help prevent or alleviate these symptoms. And although HRT has been proven to do just that, there are still many concerns about this treatment. A history of breast or uterine cancer, a history of heart disease or a family history of breast cancer would all be reasons not to go on HRT.

HRT benefits and drawbacks
With short-term use of 1 to 2 years, HRT benefits most women with minimal to no side effects, though some of the side effects a woman can experience from short-term use are vaginal bleeding, breast tenderness, mood changes, weight gain, water retention, increased risk of blood clots--particularly in the legs--and gallbladder disease.

Long-term use of HRT is a "good news-bad news" situation. It's been shown to be effective in preventing the bone loss associated with osteoporosis. But using HRT 2 or more years can increase the risk of breast and uterine cancer.

Evidence suggests that estrogen therapy can increase the risk of uterine cancer up to six- fold but adding progestin (synthetic progesterone) markedly decreases this possibility. Many physicians now prescribe the combination of estrogen and progestin to reduce this risk while providing the benefits of estrogen in prevention of osteoporosis.

Several dozen studies on breast cancer have yielded mixed results, some showing that estrogen therapy has no impact on breast cancer while others show the risk increased by 15 to 40% with long-term use, with or without progestin.

For decades many physicians believed HRT also lowered the risk for heart disease and a number of studies suggested the same. But new research indicates there isn't enough evidence to support this and HRT has actually been linked to higher rates of cardiac events during the first year of treatment. This new research also shows HRT does not help in preventing strokes.

Because the exact impact of HRT on a woman's overall health was uncertain, the National Institute of Health had started a 15-year, nationwide clinical trial with postmenopausal women. The study was to evaluate the total health effect of HRT. The study was scheduled to go until 2005 but was stopped recently, after five years, because of the increased risk of invasive breast cancer, coronary heart disease, stroke and pulmonary embolism (blood clots) associated with HRT.

With these new findings many women will choose not to use HRT, but there are natural alternatives to help ease the symptoms without the side effects.

Simple ways to treat menopause symptoms without HRT
Dietary changes can be helpful in alleviating symptoms. Limit caffeine, as it tends to increase hot flashes. Avoid spicy foods, alcohol and sugar, and increase leafy green vegetables in your diet.

Soy is a good source of phytoestrogen (plant estrogen) and provides estrogen-like effects such as relieving hot flashes. Past research suggests it may slow bone loss just as estrogen does but additional research needs to be done to prove or disprove this theory.

Black cohosh has been approved the German Ministry of Health as a treatment for hot flashes and other menopausal discomforts. From 1982 to 1991 German researchers conducted trials on 1170 women and the effects of black cohosh, in the form of Remifemin, on menopausal symptoms. The largest study of 629 women found that 80% showed marked improvement in symptoms in a month and most showed complete relief of symptoms in 6 to 8 weeks with no adverse side effects.

Natural progesterone (wild yam) cream may help with hot flashes. To treat hot flashes, the cream is rubbed onto breasts, chest, lower abdomen and inner thighs twice daily.

Supplements can also help. Calcium with vitamin D can help with bone loss. Vitamin C can help with bleeding, increases iron absorption and increases tissues strength of the perineal structures. Bioflavonoids also help with heavy bleeding, decrease water retention, ease sore joints and decrease hot flashes.

Menopause is a very personal time of change and each woman will experience it differently. Research all the information available on the risks and benefits of HRT and natural alternatives and discuss them with your health care provider to help make the choice that's right for you.

For more information:

• The National Library of Medicine's MedLine service has a tracking page on HRT news and studies [1] so that you can keep up to date with the latest information.

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© 1999-2005 Esther Rumfelt. Used by permission.