Menopause has occurred when a woman has not had a period for twelve months. The average age of menopause is 52. Symptoms of menopause include: Hot flashes Night sweats Sleep disturbance Palpitations Headache Fatigue Weight gain Joint pain Decreased sexual desire and response Vaginal dryness and painful intercourse Urinary control problems Anxiety Depression Osteoporosis Treatment Options Treatment options for menopause are directed at controlling symptoms, maintaining quality of life, and decreasing menopausal health risks. Treatment options available for women include: Traditional combination estrogen/progesterone therapy, or hormone replacement therapy (HRT) Traditional estrogen replacement therapy (ERT) Bioavailable or "natural" hormone replacement therapy Nutritional and herbal supplements Medications utilized to relieve specific symptoms of menopause Traditional Hormone Replacement Therapy The FDA has approved the use of ERT for the following indications:  vasomotor symptoms, urogenital atrophy, and osteoporosis prevention.  Progesterone should be added to Estrogen replacement for any woman with a uterus, to prevent uterine cancer, which can occur if estrogen is taken alone.  For women who have had a hysterectomy, traditional progesterone supplementation is not necessary. Traditional HRT includes medications, which are regulated by the FDA, and which are obtainable only by prescription.  These medications include various dosages and combinations of estrogens and progestogens.  Many options are available for administration, including oral, topical, and vaginal preparations. Bio-identical HRT Many women are interested in using bio-identical hormone replacement.  Bio-identical hormones are simply the exact chemical structure that our bodies naturally synthesize.  Some pharmaceutically manufactured hormones are bio-identical hormones, and some are structurally similar hormones that our bodies then convert into usable hormones. Specialized pharmacies, called compounding pharmacies, are able to supply bio-identical hormone preparations that are dose specific to your needs.  Dr. Evans recommends that when you work with a compounding pharmacy you ensure that the pharmacy is a member of PCCA (Professional Compounding Centers of America).  Medications formulated by compounding pharmacies are not FDA regulated and a pharmacies' membership in PCCA will ensure that the pharmacy abides by strict quality control guidelines.  Dr. Evans works closely with TriState Compounding Pharmacy, a member of PCCA, to provide bio-identical hormone replacement for her patients who desire this treatment.  More information about TriState Compounding Pharmacy can be obtained from www.tristaterx.com. Though bio-identical hormone replacement has been utilized for many years, there have been no large double-blinded, controlled studies to evaluate its safety and efficacy.  The use of bio-identical HRT is not approved or regulated by the FDA.  While it seems that using bio-identical hormones should be safe, there is no scientific evidence to either support or disprove that this is the case.  The American College of Obstetrician-Gynecologists states that "Given the lack of well-designed and well conducted clinical trials of these alternative therapies, compounded hormone products should be considered to have the same safety issues as those associated with hormone therapy agents that are approved by the FDA." (ACOG committee opinion #322, Nov. 2005) Dr. Evans does offer bio-identical hormone replacement therapy.  She works closely with TriState Compounding Pharmacy at www.tristaterx.com to provide this option. Nutritional and Herbal Supplements Dietary supplements and herbal medications can be obtained without a prescription and are sometimes used for treatments of menopausal symptoms.  Safety and efficacy is largely unknown.  Some alternatives have been used for many years and are likely therapeutic but we need more scientific information about them and their potential interactions with other medications. More information regarding herbal preparations can be obtained from the National Center for Complimentary and Alternative Medicine at www.nccam.nih.gov. Medications used to relieve symptoms of menopause Prescription medications are available that may treat hot flashes, but are not FDA approved for this use.  Medications are also available for sleep difficulties and depression.  Dr. Evans will be happy to discuss these alternatives with you. Menopause is a natural event.  This does not mean that it is normal for women to suffer though the unpleasant consequences of menopause.  Each woman must take an active role in decisions regarding her own treatment plan.  Many resources are available to aid in making these decisions and women are encouraged to utilize all resources available to them.