Stress Resilience....

Our ability to cope with stress peaks at 25 & 65. Where does that leave us in-betweeners? Perimenopause in particular catapults into a state of half our normal stress resilience, mostly due to the hormonal chaos of wildly fluctuating estrogen and dropping progesterone levels.

Recently I offered an interactice teleconference for Up2yoga on Stress Resilience. Listen to the podcast right here. Learn natural ways of creating more stress buoyancy with adrenal support and balancing your sex hormones (estrogen, progesterone, testosterone). Join me for our next interactive teleconference on July 8, 2010 at 10am from anywhere in the world for $1 right here.

goodbye to my period

while i'm not there yet, i am drawn to this gorgeous poem by lucille clifton. i'm planning a huge party for my one-year anniversary after my final menstrual period, and you're all invited. we don't sufficiently honor these important rites of passage for women: final period, miscarriage, abortion. thank you, fleur, dear patient of mine, for introducing me to this lovely poet and choosing an appropriate quilt to match!

to my last period

 

well girl, goodbye,

after thirty-eight years.

thirty-eight years and you

never arrived

splendid in your red dress

without trouble for me

somewhere, somehow.

now it is done,

and i feel just like

the grandmothers who,

after the hussy has gone,

sit holding her photograph

and sighing, wasn't she

beautiful? wasn't she beautiful?

            -Lucille Clifton

From Lucille Clifon's book Quilting: Poems, 1987-1990 (BOA, 1991)

Insomnia in Perimenopause

There are very few things more important than sleep. You know that, especially if you're not getting enough.

Unfortunately, many of my fellow perimenopausal travelers in their 40s and 50s are not getting enough. Suddenly you're 44 and your sleep is disrupted by awakenings at 2am, 3am, 4am. The most common patterns fall into one of two categories of altered sleep architecture: poor sleep maintenance (the afore-mentioned awakenings, often with the mind racing and the editor telling you all the ways in which you fall short of expectations) or poor sleep latency (e.g., they have adrenal dysregulation and get a second wind at night, which keeps them up late and unable to fall asleep).

The short version for perimenopausal seekers of a good night's sleep is the following.
1. Stop all caffeine
2. Get regular cardiovascular exercise, preferably 5-6 days per week for 45 min at moderate to high effort
3. Stop all wine
4. Sleep in a room at 64 degrees F or cooler
5. Consider daily estrogen and progesterone. Micronized progesterone has been shown to be the most effective.

These simple 5 steps are non negotiables if sleep is elusive. I've had many patients retort that they just have one cup of black or green tea in the morning, or just one glass of wine at dinner. Yes, even one serving makes a difference.


Artificial lights put us out of sync with nature. Limit your exposure at night. Get all LEDs out of the bedroom. Sleep in a very, very dark room at 64 degrees. For more data on how to eat, the effect of carbs, and best ways to game sleep, consider reading TS Wiley's Lights Out. Or join our next Gottfried Center Cleanse -- it's amazing how the group structure assists us with getting off of toxins such as caffeine, sugar and alcohol, and deeply benefits your sleep.

And if you're part of our current Cleanse-in-Progress, let us know how you're sleeping!

Think You're Goin' Crazy During Perimenopause?

You are. We lose our minds, can't remember sh%@,  & don't sleep restoratively. --SG


Role of psychiatric comorbidity on cognitive function during and after the menopausal transition
Jeanne Leventhal Alexander†, Barbara R Sommer, Lorraine Dennerstein, Miglena Grigorova, Thomas Neylan, Krista Kotz, Gregg Richardson and Robert Rosenbaum

While cognitive complaints are common during the menopausal transition, measurable cognitive decline occurs infrequently, often due to underlying psychiatric or neurological disease. To clarify the nature, etiology and evidence for cognitive and memory complaints during midlife, at the time of the menopausal transition, we have critically reviewed the evidence for impairments in memory and cognition associated with common comorbid psychiatric conditions, focusing on mood and anxiety disorders, attention-deficit disorder, prolonged stress and decreased quantity or quality of sleep. Both the evidence for a primary effect of menopause on cognitive function and contrarily the effect of cognition on the menopausal transition are examined. Impairment in specific aspects of executive function is explored. Evaluation and treatment strategies for the symptomatic menopausal woman distressed by changes in her day-to-day cognitive function with or without psychiatric comorbidity are presented.

Expert Rev. Neurotherapeutics 7(11), S155–S178 (2007)

Hormone Therapy Helps Brain Fog

Here's a study showing that hormone therapy helps women in perimenopause, which can last 10 years, with brain fog, memory trouble, word finding & other cognitive problems. However, you get better if you start hormones before your final menstrual period (this is a recurring theme in the hormone literature). If you start hormones after your final menstrual period, you get worse. That sucks. More good news: postmenopause, your cognition rebounds back to premenopausal levels. -- SG

Effects of the menopause transition and hormone use on cognitive performance in midlife women.
Greendale GA, Huang MH, Wight RG, Seeman T, Luetters C, Avis NE, Johnston J, Karlamangla AS.

Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095-1687, USA. ggreenda@mednet.ucla.edu
BACKGROUND: There is almost no longitudinal information about measured cognitive performance during the menopause transition (MT). METHODS: We studied 2,362 participants from the Study of Women's Health Across the Nation for 4 years. Major exposures were time spent in MT stages, hormone use prior to the final menstrual period, and postmenopausal current hormone use. Outcomes were longitudinal performance in three domains: processing speed (Symbol Digit Modalities Test [SDMT]), verbal memory (East Boston Memory Test [EBMT]), and working memory (Digit Span Backward). RESULTS: Premenopausal, early perimenopausal, and postmenopausal women scored higher with repeated SDMT administration (p < or = 0.0008), but scores of late perimenopausal women did not improve over time (p = 0.2). EBMT delayed recall scores climbed during premenopause and postmenopause (p < or = 0.01), but did not increase during early or late perimenopause (p > or = 0.14). Initial SDMT, EBMT-immediate, and EBMT-delayed tests were 4%-6% higher among prior hormone users (p < or = 0.001). On the SDMT and EBMT, compared to the premenopausal referent, postmenopausal current hormone users demonstrated poorer cognitive performance (p < or = 0.05) but performance of postmenopausal nonhormone users was indistinguishable from that of premenopausal women. CONCLUSIONS: Consistent with transitioning women's perceived memory difficulties, perimenopause was associated with a decrement in cognitive performance, characterized by women not being able to learn as well as they had during premenopause. Improvement rebounded to premenopausal levels in postmenopause, suggesting that menopause transition-related cognitive difficulties may be time-limited. Hormone initiation prior to the final menstrual period had a beneficial effect whereas initiation after the final menstrual period had a detrimental effect on cognitive performance.

Neurology. 2009 May 26;72(21):1850-7

Weight Gain in PeriMenopause & PostMenopause

Good post on how estrogens, when they are reduced by perimenopause and menopause, lower your metabolic rate. Unfortunately, this can start at early as age 35-40. Welcome to Perimenopause, My Friends! But there are things we can do about it. Read on....

Question: Does exercise attenuate or prevent the weight gain that occurs during peri- and post-menopause?

Commentary from:
Wendy M. Kohrt, PhD
Professor of Medicine
University of Colorado, Denver
in Menopause E-consult by the North American Menopause Society

The short answer is, yes, exercise can attenuate
or prevent weight gain during peri- and
postmenopause. The prevention of weight gain
at any age requires only that energy intake not
exceed energy expenditure. Thus, it is possible
to maintain body weight by modifying exercise
and/or eating habits. However, although simple
in theory, there are physiologic changes that
make it particularly challenging for middle-aged
women to maintain energy balance (ie, intake =
expenditure). Because the menopause transition
occurs over a number of years, it is difficult to
determine whether the increased propensity for
weight gain at midlife is primarily a
consequence of the menopause transition or of
advancing age. Both involve factors that make
weight maintenance a challenge.

Menopause-related factors that promote weight
gain. Studies of laboratory animals provide
compelling evidence that estrogen plays an
important role in the regulation of body weight.
Oophorectomy has consistently been found to
cause excess weight gain, and this is prevented
by estrogen replacement.1 There appear to be
multiple mechanisms by which estrogen
deficiency leads to weight gain in animals,
including increased food intake, decreased
spontaneous physical activity, and a suppression
of metabolic rate. If such effects of estrogen
deficiency also occur in humans, this would
suggest that there is a “biological drive” around
the time of menopause toward weight gain.

In fact, there is evidence that estrogen regulates
body weight in women. A number of large,
randomized, placebo-controlled, and open-label
trials of estrogen-based hormone therapy (HT)
have provided strong evidence that weight gain
and, more specifically, fat gain, is attenuated in
women on HT when compared to women on
placebo or no HT.2 Suppressing sex hormone
levels in premenopausal women with
gonadotropin-releasing hormone (GnRH)
agonist therapy also causes fat gain. For
example, women treated for 16 weeks with a
GnRH agonist gained 1.0 kg of fat, which
equates to an energy excess of about 80 kcal per
day.3 Because it is difficult to accurately
measure changes in energy intake and
expenditure of this magnitude in humans, it is
not clear whether the suppression of sex 2
hormones influences eating and/or exercise
habits. However, short-term hormone
suppression has been found to cause a decrease
in resting metabolic rate of 40 to 70 kcal per
day.4 This reduction in metabolic rate would be
expected to cause weight gain if not
accompanied by a compensatory decrease in
energy intake or increase in physical activity.

Aging-related factors that promote weight gain.
Even if the menopause transition does not alter
bioenergetics in a way that promotes weight
gain, there are unavoidable factors related to
aging that do so. Two important factors are the
loss of muscle mass and the decline in maximal
aerobic power. Lean body mass is an important
determinant of resting metabolic rate. As lean
mass declines with aging, there is a decrease in
metabolic rate and, therefore, daily energy
expenditure. The decline in metabolic rate will
result in weight gain unless appropriate
behavioral changes are adopted (ie, decrease in
energy intake or increase in physical activity).

Maximal aerobic power, also referred to as
aerobic capacity or VO2 max, is a direct index of
the rate at which an individual can expend
energy during exercise. For example, a healthy
young woman with an average VO2 max for her
age can easily increase her energy expenditure
by 8 to 10 kcal per minute during exercise.
However, there is a decline in VO2 max with
aging that cannot be avoided, due in part to the
inevitable decrease in maximal heart rate (ie,
maximal heart rate = 220 minus age).
Accordingly, with advancing age there is a
decline in the rate at which energy can be
expended during exercise, even in people who
maintain a vigorous level of physical activity.5
Rather than being able to increase energy
expenditure by 8 to 10 kcal per minute during
exercise, middle-aged women may be able to
burn only 6 to 8 kcal per minute. This has an
important impact on how women can use
exercise to maintain body weight as they age.
Because the rate at which energy can be
expended decreases gradually with aging,
maintaining the same level of total exercise
energy expenditure may require an increase in
the amount of exercise time.
Do physically active women gain less weight
than sedentary women during peri- and
postmenopause? Exercise can prevent weight
gain in peri- and postmenopausal women, but
factors related to menopause and aging make
weight maintenance a challenge. Even though
regular exercise does not come with a guarantee
against weight gain, prospective studies of
perimenopausal women indicate that the most
active women gain the least weight.6,7 Most
important, women should not abandon their
exercise habits if they become discouraged by
what they perceive as a lack of effectiveness of
exercise to prevent weight gain. Exercise has
numerous health benefits that are independent of
its effects on body weight regulation.8

Disclosure: Dr. Kohrt reports: Research support—
National Institutes of Health.

References:
1. Shi H, Clegg DJ. Sex differences in the regulation of
body weight. Physiol Behav 2009 Feb 27. [Epub ahead of
print]
2. Lobo RA. Metabolic syndrome after menopause and
the role of hormones. Maturitas 2008;60:10-18.
3. Yamasaki H, Douchi T, Yamamoto S, Oki T,
Kuwahata R, Nagata Y. Body fat distribution and body
composition during GnRH agonist therapy. Obstet
Gynecol 2001;97:338-342.
4. Day DS, Gozansky WS, Van Pelt RE, Schwartz RS,
Kohrt WM. Sex hormone suppression reduces resting
energy expenditure and beta-adrenergic support of resting
energy expenditure. J Clin Endocrinol Metab 2005;90:
3312-3317.
5. Hawkins SA, Marcell TJ, Victoria JS, Wiswell RA.
A longitudinal assessment of change in VO2 max and
maximal heart rate in master athletes. Med Sci Sports
Exerc 2001;33:1744-1750.
6. Sternfeld B, Wang H, Quesenberry CP Jr, et al.
Physical activity and changes in weight and waist
circumference in midlife women: findings from the Study
of Women’s Health Across the Nation. Am J Epidemiol
2004;160:912-922.
7. Macdonald HM, New SA, Campbell MK, Reid DM.
Longitudinal changes in weight in perimenopausal and
early postmenopausal women: effects of dietary energy
intake, energy expenditure, dietary calcium intake and
hormone replacement therapy. Int J Obes Relat Metab
Disord 2003;27:669-676.
8. Haskell WL, Lee IM, Pate RR, et al. Physical activity
and public health: updated recommendation for adults
from the American College of Sports Medicine and the
American Heart Association. Circulation 2007;116:1081-
1093.

Stress, Neurotransmitters, Hormones & YOU!

Are you less stress resilient than you used to be? More overwhelmed by your demands? Irritable and burned out?

The four of us, Drs. Abbassi, Nunley, Massey and me, have been discussing this a lot as we have seen many patients recently who have been under chronic stress for a long, long time. They have sleep problems, brain fog, and do not wake up restored in the morning.

We have many patients who recall life in their 20s: able to focus, concentrate, stay on task, cope with the exigencies of daily life. They rested and relaxed when they could, and enjoyed their time off. Now the weekend is not enough: relationships are more conflictual, home life is not the respite it used to be, achievement doesn't come as easily, which only adds to the stress.

Here are some of the results of chronic stress:

• Insomnia
• Autism
• Poor mood, mood swings
• Anxiousness, irritability, agitation, tension, panic attacks
• Difficulty concentrating, focusing or remembering
• Headaches
• Fatigue, lack of energy
• Weight issues, especially food cravings

Often these symptoms are a result of the body's difficulty responding to chronic stress. The adrenals and brain just can't keep up with the demand. The supply of feel-good neurotransmitters and hormones are limited by diet, genetics and often exposure to toxins.

One helpful approach we've found is to take the following approach:
1. Replace the hormones that are depleted or out of balance, all with bioidentical hormones, all tailored to you and your particular physiology and integrated with your risk factors and genetic disposition. This includes estrogen, progesterone, DHEA, testosterone, cortisol, and thyroid. We often use supplements and nutrition to optimize results.
2. Measure neurotransmitters and develop a customized amino acid protocol based on your results.
3. Make lifestyle and nutritional adjustments, along with refinement of bioidentical hormones and amino acids as needed in the long-term.

We've found this is the best approach for reversing the impact of chronic stress. The result? Vitality. Joy. Love. Less conflict. Connectedness to True Self. Satisfaction. Contentment.

Dr. Marsha Nunley, MD, Joins Gottfried Center

We are tremendously blessed to have Dr. Marsha Nunley, MD, integrative internist, join us this month. She began the first week in January to rave reviews and extraordinary service and care. Dr. Nunley is 50-something and has the energy, vitality and beauty of a 30-year-old. She is certified in the Wiley Protocol and Age Management; extremely facile with all areas of bioidentical hormone balancing for men and women especially thyroid, adrenal estrogen/progesterone/testosterone; transformative in her care of complex medical problems; board-certified in Internal Medicine, Palliative Care and Pain Managment, and quite simply, a lovely person and doctor. Dr. Nunley also completed Dr. Andrew Weil, MD's Integrative Medicine Fellowship at the University of Arizona when it first opened.

Dr. Nunley, MD, is full-time at our newly expanded Gottfried Center for Integrative Medicine, Monday-Thursday. She has special introductory rates for initial consultation in January and then her regular fees kick in February, 2009.

Revisiting Hormone Therapy in Women

Happy Holidays. Here is a nice summary of the latest view, albeit conventional, from the Harvard Women's Health Watch, Dec 2007. SG

Harvard Women's Health Watch | December 2007

Revisiting hormone therapy’s risks and benefits

A more nuanced picture may emerge as researchers re-examine data from the government’s massive postmenopausal hormone trials.

Hormone therapy has long been the standard treatment for relieving menopausal symptoms: hot flashes, night sweats, and vaginal dryness. Until 2002, many clinicians were also recommending it long term to prevent chronic health problems, including heart disease, stroke, and osteoporosis. There was some evidence that estrogen might contribute to breast cancer, but except for women at especially high risk for that disease, cardiovascular disease was a more serious concern — a far greater cause of death and disability. For that reason, most health organizations recommended that postmenopausal women consider taking hormone therapy.

Then, in 2002, the hormonal approach to averting women’s later-life ills screeched to a halt. Researchers had to stop the Women’s Health Initiative (WHI) randomized trial of estrogen and progestin (in the form of Prempro) because the hormone combination was actually causing more heart attacks and strokes than a placebo, as well as more blood clots and breast cancer.

Two years later, the WHI’s trial of estrogen alone (Premarin), also ended early, after it became apparent that estrogen increased the rate of strokes and blood clots without conferring any benefits on the heart.

Although there were some benefits — fewer fractures in both trials and a reduced risk for colon cancer in the combined-hormone trial — they didn’t outweigh the risks. That left hormone therapy back where it started, as a short-term treatment for menopausal symptoms.

Impact and critique of the WHI

Hormone therapy is still the most effective treatment for hot flashes and night sweats. But the WHI results — and the associated media firestorm — left women worried and confused about even such short-term use. They were told to use hormones only for short periods and at low doses, and hormone therapy prescriptions plummeted. (One study reported a 75% drop between 2002 and 2006.) Yet menopausal women looking for symptom relief shouldn’t misinterpret the WHI findings. These studies were not about short-term management of menopausal symptoms. Moreover, the results aren’t above criticism. New questions have arisen as scientists try to reconcile the findings of earlier observational studies with those of the WHI — a randomized, placebo-controlled trial, considered the “gold standard” type of clinical investigation.

Some critics argue that the WHI results may not apply to the typical woman considering hormone therapy because most of the 27,347 participants were in their 60s and 70s — well past the perimenopausal transition and early menopause (the usual time for starting hormone therapy). Others say that the risks were overstated. Each year, for example, the women taking Prempro had only six more heart attacks per 10,000 than the women taking a placebo; among younger women, the difference was even less.

Because of these and other concerns, scientists have been re-examining the WHI data and undertaking new trials. Researchers are also reappraising earlier studies that suggested hormone therapy could prevent cardiovascular disease.

Some scientists now suggest that the cardiac risk and benefit of hormone therapy may depend on a woman’s age, particularly the age at which she starts taking hormones. This new hypothesis doesn’t change current recommendations (see chart), but it may reassure perimenopausal and newly menopausal women who are considering short-term hormone treatment for symptom relief.

Recommendations regarding hormone therapy (HT)* use

Organization

Conclusions/recommendations

U.S. Preventive Services Task Force (USPSTF)**

Recommends against the routine use of HT to prevent chronic conditions in postmenopausal women.

North American Menopause Society

Moderate to severe vasomotor symptoms (hot flashes and night sweats) are the main use for systemic HT.

Food and Drug Administration

HT should be used at the lowest dose and for the shortest time needed to reach treatment goals, although it’s not known how low you should go to reduce the risk of serious side effects. When hormone therapy is prescribed only for vaginal symptoms, consider topical vaginal products.

American College of Obstetricians and Gynecologists

Estrogens are the most effective treatment for menopausal vasomotor symptoms (hot flashes and night sweats). Their use (with or without a progestin) should be reassessed yearly. The lowest effective dose should be used for the shortest possible time to alleviate symptoms.

American Society for Reproductive Medicine

Low-dose estrogen is a valid option for many seeking short-term relief from menopausal symptoms. HT does not provide additional health benefits that would justify its use beyond the immediate relief of menopausal symptoms. HT is not indicated for the primary or secondary prevention of coronary artery disease events.

Canadian Task Force on Preventive Health Care

HT should not be used for the primary prevention of chronic diseases in postmenopausal women. To maintain heart health, women should use other preventive strategies, such as increased exercise, smoking cessation, and blood pressure control. There’s not enough evidence to make a recommendation on HT regarding stroke and death from stroke.

*HT refers to estrogen alone, or estrogen plus a progestin.

**The USPSTF did not consider the use of hormone therapy for managing menopausal symptoms.

Heart risk: Is it a matter of timing?

The lack of heart benefits in the WHI contradicts findings from observational studies, such as the Nurses’ Health Study, in which participants are followed for years but are not asked to take medications or do anything differently. In those studies, women have tended to start taking hormones closer to the onset of menopause. Researchers have observed that these women suffer fewer of the heart problems caused by atherosclerosis (for example, angina and heart attacks) than women who don’t take hormones.

The idea that hormone therapy might help protect women from atherosclerosis was biologically plausible. It’s long been recognized that women develop atherosclerosis-related heart problems at an older age than men — that is, after menopause and the decline in estrogen. And in animal studies, estrogen has been shown to slow the development of atherosclerosis.

So why might estrogen then increase the risk of heart disease in women who start taking it at an older age? Evidence indicates that estrogen can destabilize atherosclerotic plaques, the artery-clogging accumulations of cholesterol and debris that are a major source of heart disease. Estrogen appears to make plaques more vulnerable to rupture, which can result in a heart attack. Older women are more likely to have developed plaques. So for them, estrogen might do more harm than good. It may be that hormone therapy is good for the heart only during a fairly narrow window, when plaques are starting to form but are not fully developed.

Nurses’ Health Study researchers found some support for this hypothesis in 2006 in a study undertaken to shed light on the discrepancies between the WHI results and earlier research. They found a 30% reduction in risk for heart disease among women who began hormone therapy within about four years of menopause, but little or no cardiac benefit for women who started hormones either after age 60 or 10 or more years after menopause.

A reanalysis of the WHI data turned up similar evidence that timing may be a factor. Investigators reporting in the Journal of the American Medical Association (April 4, 2007) found no increased risk for heart disease among hormone users ages 50 to 59 and a suggestion of reduced risk among women who started hormone therapy within 10 years after menopause. Thereafter, the greater the gap between onset of menopause and start of hormone therapy, the greater the risk for heart disease, especially in those with a history of hot flashes and night sweats. Stroke remained a problem, regardless of time since menopause, for women receiving either estrogen alone or combined therapy. The risk for breast cancer rose after five years in women taking combined hormones, although not in those taking estrogen alone.

In an ancillary study, WHI investigators assessed coronary artery calcium, which is a marker for atherosclerosis, in 1,064 women ages 50 to 59 who’d had a hysterectomy before entering the WHI estrogen-only trial. The women took their study medications for an average of 7.4 years and then, a year after the trial ended, they underwent CT scans of the heart. Results, published in the June 21, 2007, issue of The New England Journal of Medicine, showed that the estrogen-takers had less calcified plaque in their arteries than the placebo takers, suggesting a reduced risk for future cardiovascular events. But it’s not known how long this benefit would have lasted — or whether it would have actually led to fewer heart attacks or strokes — if the women had continued taking estrogen. According to WHI investigator (and the study’s lead author) Dr. JoAnn Manson, these findings lend support to the idea that estrogen, when it’s started near menopause, may slow the early stages of plaque buildup. “But estrogen’s effects are complex, and it has other known risks,” Dr. Manson points out, so it “shouldn’t be used for the express purpose of preventing cardiovascular disease.” Also, this study did not include older women, so there’s no indication of whether age makes a difference in the way estrogen affects plaque buildup. Only a randomized trial can test the “timing” hypothesis, and until then it remains unproven.

What about breast cancer?

Initial results from the WHI’s estrogen-only trial indicated that estrogen alone reduced the risk for breast cancer by 23% over about seven years. The effect was not statistically significant (meaning that it could have been due to chance), but it was still surprising in light of the increased risk found in the combined-hormone trial after four years. So investigators decided to take a closer look. In a final report — published in the April 12, 2006, issue of the Journal of the American Medical Association — they concluded that the women taking estrogen alone were at no greater risk for breast cancer than those taking a placebo.

The difference in risk between estrogen alone versus combined estrogen and progestin is one of the unanswered questions about hormone therapy and breast cancer. In the WHI, the estrogen-only takers had undergone hysterectomy, which is different from natural menopause. Also, we don’t know yet whether the time when hormone therapy starts influences breast cancer risk in the way it does heart disease risk. WHI investigators will soon report on a follow-up study of women in the estrogen-plus-progestin trial who continued to have annual mammograms after stopping their study medications in 2002. This could shed light on how long it takes for breast cancer risk to return to normal after women stop taking combined hormone therapy.

In the meantime, several groups of researchers reported in 2007 that the rate of new breast cancers began to decline in 2003, the year hormone therapy prescriptions fell off sharply.

Selected resources

Hot Flashes, Hormones, and Your Health, by JoAnn E. Manson, M.D., and Shari S. Bassuk, Sc.D., McGraw Hill, 2007.

Is it hot in here? Or is it me? by Pat Wingert and Barbara Kantrowitz, Workman Publishing, 2006.

What it means

Women in early menopause with troublesome hot flashes or night sweats can take short-term hormone therapy without increasing their risk for heart disease. Hormone therapy should be taken only for symptoms and, like any drug, for the shortest time possible and at the lowest effective dose (although we don’t know whether lower doses are actually safer). Studies suggest that estrogen patches may be less likely to cause blood clots in the legs than oral estrogen. For some women, the major menopausal complaint is vaginal dryness, which may persist for many years. Low-dose vaginal estrogen is an effective treatment for this symptom with negligible systemic effects.

When it comes to prevention, hormone therapy reduces the chances of fractures and colon cancer. Whether its adverse effect on the heart is related to timing still needs more study. But you can reduce these risks in other ways without increasing your odds for breast cancer, blood clots, and stroke. Avoid tobacco; exercise at least 30 minutes a day; adopt a healthy eating plan; and control your blood pressure, cholesterol, and blood sugar — with medications, if necessary. Be sure to get adequate calcium (1,200 milligrams per day) and vitamin D (800 to 1,000 IU per day). And if you’re at high risk for osteoporosis, there are many medications to choose from that curb bone loss.