Options to Diminish Menopause Symptoms

Q:  I am 49 years old. My periods have been erratic for about eighteen months now: I can go for several months without menstruating, then have a nearly normal period. I have no problem with hot flashes, but have been experiencing many other symptoms: extreme fatigue, headaches, muscle aches, sleeping problems (I usually wake up several times a night, though I have little trouble getting back to sleep), "fuzzy thinking" (i.e., difficulty concentrating, memory problems, and so on), and extreme sensitivity to noise, especially at night.

My primary-care physician prescribed femHRT, but a week later I was diagnosed with a suspicious ovarian cyst (since removed), and stopped taking it, on the advice of a gynecologist, who was concerned that it might exacerbate a smaller cyst on my remaining ovary.

I have had some thinning of my bones, but that may be largely attributable to two bouts with anorexia in my late teens and early 20s.

If I have no hot flashes, is there any other reason to take femHRT?

A:  Whether or not to take estrogen is a complicated decision and depends on your risk factors for heart disease, breast cancer, osteoporosis, blood clots and Alzheimer's disease. Since your gynecologist is concerned about ovarian cysts, I agree that not taking FemHRT (brand of combination estrogen and progestin) at this time is probably wise. There are other options for treatment of your symptoms, which are very common around menopause.

Some women feel that progesterone cream helps with the insomnia, headache and aches. It should not promote growth of your ovarian cysts, but you should discuss the use of the cream with your physicians.

If you truly have thin bones or osteoporosis diagnosed by a bone density test, then you should take at least 1,500 mg of calcium a day and may also need to take medication, such as Fosamax.

If you develop hot flashes, exercise can reduce them, and several antidepressants also have been helpful in breast cancer survivors who cannot take estrogen.