About 30 million women in the United States have gone through menopause. Other symptoms include headaches, fatigue, and impaired concentration. Osteoporosis and clogging of the coronary arteries also can accelerate during menopause. Medical management of menopause commonly includes hormone replacement therapy to help reduce hot flashes and aid in the long-term prevention of osteoporosis and heart disease. Estrogen and progesterone are generally used in combination, though estrogen alone may be appropriate for a few women with surgically induced menopause.
Oral treatment is common, though estrogen also can be supplied in a skin patch or vaginal gel.
Beginning hormone replacement therapy is an individual decision that should be made in consultation with a health care provider. Side effects of hormone therapy can include premenstrual-like symptoms and cyclic bleeding resembling menstruation. Routine follow-up should include breast and pelvic exams, e.g. mammograms and PAP smears, and for some women, endometrial biopsies. Hormone therapy, including herbal therapies, may be contraindicated in patients at high risk for breast or gynecologic cancer or blood clots. Behavioral changes also can help mitigate some effects of menopause.