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General Medical Questions
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Question : I just started menopause. My hot flashes are getting worse. I am worried about taking estrogen pills. What do you suggest?
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The Trusted Source
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Howard LeWine, M.D.

Howard LeWine, M.D., is chief editor of Internet Publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.

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August 07, 2014
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First, some reassurance about short-term estrogen therapy to treat symptoms of menopause. It does not increase your risk of heart attack or stroke. Also it does not increase breast cancer risk in most women.

A word of caution if you have a higher than average risk of blood clots. Estrogen therapy can increase your chance of developing a blood clot in the leg.

If you still have a uterus, most doctors recommend taking progesterone or another type of progestin with the estrogen. This reduces the risk of uterine cancer.

Which estrogen to take? Estradiol pills or patches appear to have a lower risk of blood clots than conjugated estrogen. Symptom relief is similar.

You may still be reluctant to use hormone therapy. Or you may have a medical reason that you shouldn't use estrogen pills or patches.

Here are a few other options for treating menopause symptoms:

  • Vaginal estrogen -- A tablet, ring or cream delivers a low dose of estrogen into the vagina. This treatment can help relieve dryness, discomfort during sex and some urinary symptoms.
  • Relaxation therapy -- There is some evidence that techniques that help you attain a state of calmness and relieve stress may help with hot flashes. Examples include deep breathing, yoga and meditation.
  • Low-dose antidepressants -- Some antidepressant drugs may reduce hot flashes. They include venlafaxine (Effexor), fluoxetine (Prozac), citalopram (Celexa) and escitalopram (Lexapro).
  • Gabapentin -- This anti-seizure drug can also help with hot flashes.

 

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