Making Sense of Menopause
Aug 13, 2018 Cedars-Sinai Staff
Andrea Hill describes herself as a "typical Los Angeles woman."
Outdoors is better than indoors. Conventional isn't necessarily best. She's confident doing things her own way and asking lots of questions. She didn't just have her DNA tested through a standard online kit—she got a lab to do extra analysis.
"The biggest risk for women is that they feel they can't talk to their doctors. Your doctor can help you identify your own risk factors and come up with a plan that meets your needs."
She takes her health seriously, especially her family history of Alzheimer's and heart disease.
"I don't mess around because it's so important," says Hill, 55, who was a motion picture camerawoman for 20 years and is now a healthcare communications consultant.
Menopause brought weight gain and a host of difficult symptoms—hot flashes and night sweats, sleeplessness by night and brain fog by day. It also raised serious health questions when she looked for relief.
Like many women, Hill considered hormone replacement therapy. Her thorough research left her with more confusion. Some articles and experts said it's safe; others raised red flags for higher cancer risk. She was encouraged by studies that linked hormone therapy to lower risk of dementia, but alarmed by those warning of increased heart disease risk for some women.
"There's all these conflicting studies, and I just wanted the straight truth," she says.
The two biggest myths in hormone therapy
Chrisandra Shufelt, MD, says when it comes to hormone therapy, two myths are most common: The first is that hormone therapy is not safe for anyone; the second is that it's completely safe for everyone.
The truth is it comes down to the individual woman and her own risk factors. In healthy women, hormone therapy is unlikely to immediately increase the risk of cancer or heart disease. For women who have had cancer, or have high blood pressure, high cholesterol or diabetes, it might not be the best treatment choice.
"The biggest risk for women is that they feel they can't talk to their doctors," says Shufelt, director of the Women's Hormone and Menopause Program in the Cedars-Sinai Barbra Streisand Women's Heart Center. "Your doctor can help you identify your own risk factors and come up with a plan that meets your needs."
Hormones are not the only fix
Before hormones are prescribed, Shufelt orders lifestyle changes. The first 3 to 6 months of treatment focus on increasing exercise, improving sleep and changing diet. For some, these changes make the symptoms manageable.
Hill, who already loved daily exercise, switched up her food choices and prioritized sleep. She says she started to feel more energetic and her brain fog lifted.
"The momentum matters," Hill says. "Once you move, you get going and keep going. Get up! Make lists! Take notes! Move your body."
Find the right plan for you
After a few months fine-tuning her healthy habits, Hill started an oral hormone medication and a patch to manage her menopause symptoms. She's pleased with her combination of lifestyle changes and hormone replacement therapy—and her partnership with Shufelt.
"When you work in the medical field, you sometimes know a little too much," Hill says. "At first, I thought Dr. Shufelt was a lot more orthodox than I am. But I felt very safe. She got me on the right path."
When women look for the best menopause options, Shufelt suggests they weigh this advice:
Be wary of herbal remedies and over-the-counter supplements. These products are not regulated, so you don't know what's in them. Statistically, they seem to work about as often as placebos in clinical trials for hormone therapy.
Nonhormonal alternatives are available. Gabapentin, for example, is a drug that has been used to treat seizures. Studies show it’s as effective as estrogen for hot flashes and insomnia. Also, an antidepressant was approved recently to treat hot flashes. Cedars-Sinai research found acupuncture was 40 to 50 percent effective in treating hot flashes, and more effective in treating other symptoms such as insomnia.
Synthetic or bioidentical, a hormone is a hormone. Risks are not related to whether the medication is synthetic or so-called bioidentical hormones. The method of delivery may make a difference. For example, patches may be less likely to trigger blood clots and inflammation.
Sifting through the confusing and often-changing conventional wisdom on menopause is challenging. With no one-size-fits-all answers, partner with a doctor to find a plan that works best for you.