Menopause: Beyond Hot Flashes

Ever since the Women's Health Initiative (WHI) concluded three years ago that the long-term use of the hormones estrogen and progestin to prevent heart disease was not worth the associated health risks, women have been frustrated and confused about what to do as they go through menopause. Part of the problem is that the WHI study was never designed to look at menopause. Participants were mostly in their 60s, when more and more women begin suffering heart attacks, and not their late 40s and early 50s, when most women eventually stop menstruating. But as data presented in San Diego recently at the annual meeting of the North American Menopause Society make clear, when you go on hormone therapy—if you choose to do so—can make a big difference in the effects on the body and in particular on the brain.

There is, says Dr. Declan Murphy of King's College London, "substantial evidence that if you use estrogens around menopause, it can have a beneficial effect on your brain age." Several (but not all) studies show significant improvements in memory and cognition. If you start taking estrogen in your 60s, however, the brain seems to suffer a bit. As always, you have to balance the risks and the benefits. But these findings show how little, even now, researchers truly understand about the role estrogen plays in women's bodies.

So, what's a woman to do? The first thing is to recognize that your body is changing and remember that billions of women have gone through this before you. Indeed, many women, looking back, regard these transitional years as the best, most productive time of their life. Don't be afraid to seek treatment if your symptoms are disruptive. Low-dose contraceptives can help stabilize erratic menstrual cycles in the years leading up to menopause. Short-term hormone therapy is still the best medical solution for the relief of hot flashes and other so-called vasomotor symptoms. Certain antidepressants may play a role in relieving hot flashes and seem particularly helpful in women who want to avoid estrogen treatment because of a history of breast cancer or concern about blood clots.

Menopause is also a good time to get serious, if you haven't already, about adopting a healthy lifestyle. A diet that contains lots of fruits and vegetables and plenty of fiber becomes even more important at midlife. Regular exercise—aerobic and muscle building—is not only good for your heart and bones; it can also help your body deal with sudden temperature changes. "Those aren't necessarily the sexy answers that people want to hear," says Dr. Cynthia Stuenkel of the University of California, San Diego. But they are the kind of no-nonsense steps that anyone who has reached middle age would do well to consider.