Few options exist beyond hormones to combat severe symptoms like hot flashes that strike hourly, experts contend. "We can prescribe antidepressants, but they're not indicated for this purpose and they have their own set of side effects," says Schiff, who has no financial ties to the pharmaceutical industry. Some women try soy or black cohosh supplements, but studies haven't shown those really work, he adds. "We're left recommending lifestyle changes—avoid caffeine, don't wear layers, try yoga, exercise, lose excess weight—but some women still don't get relief."
As scary as the new evidence is, experts say it's hardly the final word on hormone therapy. The Women's Health Initiative mainly included women who were a decade or two beyond menopause rather than those just beginning the transition. Some evidence suggests that if women start hormone therapy early in menopause before their arteries become clogged with plaque, HRT may help their vessels stay clear, conferring heart benefits. "The study also used different hormonal regimens than the lower-dose therapies we use today," says Schiff. Several studies are now underway to see if the same risks found in the WHI apply to younger menopausal women taking today's drug formulations.
When deciding whether or not to take hormone therapy, a woman should weigh the severity of her own symptoms—and how much they interfere with her quality of life—against the small increased health risks, says Alan Altman, a Colorado-based gynecologist who specializes in treating menopause problems. Most of the time, he says, the therapy can smooth a hormonal transition that would have otherwise been choppy.
The American College of Obstetricians and Gynecologists recommends that menopausal women who choose to take hormone therapy do so at the lowest dose for the shortest period of time possible—advice the group is likely to stick with, says spokesperson Stacy Brooks. Altman recommends that women who go the HRT route give themselves a year or two to gradually wean themselves off the hormones, allowing their bodies time to adjust. This will help them avoid a resurgence of symptoms. Those who do have a recurrence, he says, usually find their symptoms are "nowhere near as bad" as they were initially.