Q I took HRT for years. Is my health at risk?

Dr. Heise: The Women's Health Initiative HRT study alarmed many people. It showed that taking Prempro-estrogen plus progestin-decreased a woman's risk of colon cancer and hip fracture while increasing her risk of breast cancer, blood clots, stroke and heart attack. However, the general risk is low; for every 10,000 women on HRT, there would be 20 additional events per year. And it doesn't mean that all these events lead to death. The risks of taking HRT aren't prohibitive. Some women's lives are so disrupted by menopausal symptoms such as hot flashes, night sweats and vaginal dryness that they still use HRT. Each individual must decide if she is willing to take the risk.

Q What can I use besides HRT to stop hot flashes?

Dr. Heise: Soy and black cohosh supplements help some women, while antidepressants in the category called serotonin reuptake inhibitors are effective for others. In some cases, nothing works to control hot flashes except estrogen.

Q Why was I tired after stopping HRT?

Dr. Heise: Most menopausal fatigue is the result of being kept awake by night sweats caused by lower estrogen levels. Limiting caffeine, alcohol and spicy food may decrease hot flashes and night sweats.

Q How can I control vaginal dryness?

Dr. Heise: I tell my patients to first try an over-thecounter vaginal moisturizer or lubricant. Then we talk about vaginal estrogen preparations, which are often effective and provide a lower dose of estrogen than oral HRT.

Caroline Heise, MD, specializes in gynecology at Doylestown Hospital.