Many women will see relief from symptoms and improved quality of life with estrogen, according to Manson, who is also professor of medicine at Harvard Medical School, in Boston.
However, "any woman who doesn't have symptoms of hot flashes, night sweats or other menopausal symptoms is not a candidate," Manson stressed. Other patients who would not be considered candidates for HRT are women with a history of hormone-sensitive cancers such as endometrial or breast cancer and/or a history of heart attack, stroke or blood clots in their legs, heart or lungs, she said.
In these cases, antidepressants -- such as the widely used family of selective serotonin reuptake inhibitors (SSRIs), which include Celexa, Prozac, Paxil and Zoloft -- might be used. Alternatively, the anti-seizure drug gabapentin may help relieve symptoms for some, Manson said.
"There are some non-hormonal prescription medications that are better studied now than they have been in the past and may be very reasonable options, especially for women who are not candidates for hormones or who would prefer a non-hormonal option," she added.
The report also looked at acupuncture, but found that the evidence to support its use against menopausal symptoms is mixed at best.
Dr. Lila E. Nachtigall is a professor of obstetrics and gynecology at New York University Langone Medical Center in New York City. She agreed that, when used on its own, estrogen can still be safe and effective in treating the symptoms of menopause.
"If a woman has symptoms and there is not an absolute contraindication, we should be using estrogen again," she believes. "We use the lowest dose for the shortest period of time that reaches the therapeutic goal." According to Nachtigall, that goal is typically the relief of menopausal symptoms.
Dr. Steven R. Goldstein, a professor of obs
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