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Dr. Julie Gould, St. Luke's Hospital

Tailoring treatment for menopausal symptoms

Do you have hot flashes, sleepless nights or loss of libido? How about emotional changes, breast tenderness or pain with intercourse?

The list of menopausal symptoms goes on and on. You may have one symptom, or you may have them all. Regardless, you should know that you have many treatment options.

Traditionally, the mainstay of treatment for menopausal symptoms has been hormone replacement therapy (HRT), which provides women with estrogen, progesterone and/or testosterone. HRT comes in different forms: pills, creams, gels, patches, lozenges and even mists.

If you prefer a non-hormonal approach, supplements such as black cohosh and chasteberry have been found to have some success in relieving menopausal symptoms. Soy products have also been used to treat hot flashes and vaginal dryness.

In addition, certain medications intended for the treatment of high blood pressure or depression have the nice side effect of treating menopausal symptoms as well.

It's important to make sure your physician offers a wide variety of treatments. Some simply offer a trial of hormone therapy only to appropriate candidates, but others offer intense monitoring of hormone values through blood or saliva testing along with a thorough evaluation of symptoms, counseling and regular follow-up visits.

Your specific treatment options will probably depend on what symptoms you are having, your medical history and your level of comfort with different approaches. You and your physician should discuss the risks and benefits of the various options before you make any decisions.

No single treatment is perfect for everyone, and keep in mind that your symptoms may change over time. Menopausal symptoms can start as early as ten years before your last period and continue up to ten years or more after your last period. Some symptoms like hot flashes and irregular menstrual cycles may go away; however, some symptoms like vaginal dryness and loss of libido may persist throughout the rest of your life. Expectations for symptom duration are different for every woman, but your mother's symptoms during menopause may offer some clues as to what you can expect.

Whatever treatment options you and your physician determine are best for you, it will be about two months before you can say conclusively that the treatment provided a benefit or failed. If you don't find the right option on your first try, be patient and try again. Finding the right approach is often a case of trial and error, and it might take multiple attempts to find what works best for you.

Dr. Julie Gould is a board-certified OB/GYN at St. Luke's Hospital. Call 314-205-6788 or visit her Meet the Doctor page.

This article was published in the St. Louis Post-Dispatch on August 26, 2010.

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