Is Low-Dose HRT Safe for Menopause Symptoms?

Expert Tracy Gaudet's advice on when to consider low-dose HRT, nonhormonal treatments, and more.

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I'm a 49-year-old woman struggling with menopausal symptoms, including hot flashes, depression, and emotional swings. Is a blood test for estrogen levels worthwhile? (I saw Suzanne Somers talk about this on Oprah.) And is low-dose hormone replacement therapy a valid treatment for these symptoms, or is it too risky?

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There are many approaches to menopausal symptoms that can help with this transition. Some of them are hormonal, many are not, and all of these decisions need to be individualized depending on your personal health history, your family history, and the symptoms or issues you are trying to address. In other words, there is no approach that fits all, and having a health provider you trust and who will work with you as you make decisions along this journey is critical.

OK, so you are 49 years old. The FSH (follicle stimulating hormone) level can indicate whether you are hormonally menopausal at this time. This hormone signals your ovaries to develop an egg. When you are not ovulating, it keeps getting higher and can therefore indicate if you are in menopause. An estradiol level will also tell you if your circulating estrogen levels are consistent with premenopausal levels or post-menopausal. In your situation, these levels can help delineate whether your symptoms are due to hormonal changes or other causes need to be investigated.

If indeed these symptoms are due to menopause, which is likely, low-dose HRT is certainly an option that you can consider. The risks and benefits need to be evaluated by a health provider who knows you. In any event, I would recommend you first try nonhormonal approaches, which are often very effective at managing these symptoms. If not, then consider hormone therapy.

Midlife is a perfect time to pull back and reflect on your life and your health. What is in balance, and what is not? Think about all aspects of your health—your nutrition, your movement and exercise, the quality of your relationships, the level of your stress, etc. All of these factors, as well as your genetics, affect how you go through menopause. Optimizing your health habits can have a very real impact on these symptoms.

Reducing triggers in your diet, such as hot tea and coffee or wine, can make a big difference, as can exercising regularly. You should practice a stress-reduction technique such as paced breathing at least once a day. [Editor's note: Gaudet's book, Consciously Female, offers more information on integrative medicine and women's health.] Acupuncture can also ease these symptoms, and massage can help as well. The most important things are to individualize your strategy based on your symptoms and your risk factors, and to realize it is a process. Whatever course you choose, continue to re-evaluate it along the way. What is right for you now might not be right for you in six months or a year.

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