What to do if menopause makes you miserable

Start with a visit to your doctor. If you don't have one you really trust, fix that problem before you try to tackle the rest, women's health experts recommend.

A good doctor will do an exam to make sure menopause is what is causing your symptoms, take stock of which ones are most bothering you, and help you weigh the benefits and risks of treatment options with your medical history in mind. For example, women bothered most by sleep problems may find a non-hormone solution. Ditto for vaginal dryness.

Hormone therapy - taking estrogen, progestin or both - works. It tames hot flashes, improves sleep, keeps bones strong and prevents vaginal dryness. It also can raise the risk of cancer and heart problems. However, studies show that the risk is small to an individual woman who starts on the pills at normal menopause age and uses them for fewer than five years.

Experts suggest:

• If you use hormones, use the lowest dose for the shortest time possible, and try to quit or cut down every few months.

• Ask about ways to use hormones other than taking pills, such as estrogen patches that can be cut to adjust the dose, or estrogen-secreting vaginal rings. Some preliminary research suggests these modes may be safer than taking pills.

• Do not take hormones to try to prevent heart disease or dementia. If you take them to keep your bones strong, talk with your doctor about possible alternatives.

• If you were taking birth control pills for symptoms during the transition into menopause, check with your doctor about whether to continue. Many oral contraceptives contain far more estrogen and progestin than traditional hormone replacement therapy does.

• For hot flashes, try to figure what triggers one, such as hot drinks, spicy foods, alcoholic drinks, stress, hot weather, or a warm room. Dress in layers, and keep your office and home cool.

• Eat a healthy diet to keep bones strong, maintain a healthy weight, get regular exercise and don't smoke.

• To sleep better, go to bed and wake up at the same time every day, eat regular meals at regular times, and not late at night. Limit caffeine. Avoid nightcaps: Alcohol may make you feel drowsy, but it interferes with sleep patterns.

• Creams can help with vaginal dryness.

• Sources: U.S. Food and Drug Administration, American College of Obstetricians and Gynecologists, National Heart, Lung and Blood Institute.