Hormone replacement therapy (HRT)
To alleviate menopausal discomfort and protect against health problems associated with decreased hormone production, doctors usually prescribe hormone replacement therapy (HRT), which combines estrogen with progestin (a form of progesterone). In women who have had their uterus removed (by hysterectomy), estrogen alone (estrogen replacement therapy, or ERT) is used. Estrogen may be administered in many forms, including pills or tablets, vaginal creams, vaginal ring inserts, implants, injections, or patches that stick to the skin. Progestin is usually taken in pill form (sometimes in the same pill as estrogen), but is also available as an IUD (intrauterine device), vaginal gel, or injection. Progestin is included in HRT because ERT has been linked to an increased risk for endometrial cancer (cancer of the lining of the uterus) and progesterone protects against this form of cancer. Because women who have had their uterus and cervix removed are not at risk for endometrial cancer, they may use ERT alone. Taking HRT for a short time (perhaps for a few years) may relieve symptoms such as hot flashes. Long-term HRT helps delay osteoporosis, and studies suggest it may also help improve cholesterol levels and protect against heart disease.¹

Risks of HRT/ERT
Both HRT and ERT can have side effects such as bloating, breast tenderness, cramping, irritability, depression, and sometimes spotting or even a temporary return of monthly periods. Doctors may be able to control these side effects by changing the amount of hormones or the method in which they are administered. HRT has also been associated with an increased risk for breast cancer^2-4 and blood clots;^5,6 thus doctors may be reluctant to prescribe HRT for women already at high risk for blood clots or breast cancer. For women with a family history of osteoporosis, a doctor may decide that the benefits of HRT outweigh the potential risks.^7-9 A new class of medicines known as SERMs (selective estrogen receptor modulators) may provide many of the benefits of ERT without some of the negative side effects. Raloxifene (approved by the FDA for prevention of osteoporosis) and tamoxifen (approved for breast cancer treatment and prevention) are two examples of SERMs. These two SERMs do, however, have a risk of blood clots similar to ERT.

Nutritional/lifestyle factors
Several dietary and lifestyle factors can have an impact on menopausal symptoms. Smoking and the consumption of caffeine or alcohol should be avoided because they can contribute to hot flashes. Exercise can play an important role in reducing a woman's risk for osteoporosis and cardiovascular disease. Nutrients that contribute to bone mineralization, such as calcium, magnesium, vitamin D, boron, and vitamin C, may also be helpful. Vitamin E consumption may help control hot flashes, protect against cardiovascular disease, and may also have a protective effect against breast cancer.^10-12 æ

There are several plant substances that may also be helpful for alleviating menopausal symptoms. Soybeans contain compounds known as isoflavones, which may help control hot flashes¹³ and reduce the risk of breast cancer,¹⁴ osteoporosis,¹⁵ and cardiovascular disease.^15,16 Another isoflavone-containing plant, red clover, also appears to reduce cardiovascular risks.¹⁷ Studies indicate that herbs such as black cohosh,^18,19 sage, and alfalfa²⁰ may be helpful for women suffering from hot flashes. Herbalists commonly recommend evening primrose oil and dong quai to alleviate menopausal symptoms, but there is little scientific evidence to support such use.