Q: I’m at the end of my rope with menopause. What can help?

You describe the top symptoms of menopause: interrupted sleep, heart palpitations, hot flashes, night sweats, memory loss, vaginal dryness, painful sex, and irritability. You note that this is affecting everyone around you--people you love--as well as yourself, which I hear described by many.

You say you’ve been researching hormone replacement therapy, and have found a lot of different opinions. For the combination of symptoms you describe, the most effective treatment option for you will be systemic hormone therapy (HT).

If you have one or two or even three of the symptoms, you can think about a sleep aid and an antianxiety/antidepressant for the irritability--and continue to address the symptoms one by one. But to address all of these, the answer is HT. A recently published book does a great job of reviewing HT; it’s called Estrogen Matters, by Avrum Bluming and Carol Tavris. Your personal health history may determine the specifics of HT selection: when was your last menstrual period, do you have a uterus, and so on.

The good news is that these symptoms won’t last forever (the vaginal dryness and painful intercourse will likely recur when you stop HT at some future time, but can be addressed with localized therapy).

You sound like the perfect candidate to trial HT. If it works fabulously, great! Use it and enjoy the benefits for a year, a decade, or four decades. If it isn’t that helpful, then you know and can look to other options. There’s always the options of just “toughing it out,” but I wouldn’t recommend that. Life is too short.

I remind women that you just had 40 years of an abundance of circulating hormones; do you think a couple of more years (or a decade) is harmful? No, it isn’t, and the evidence (best reviewed in Estrogen Matters) strongly suggests important health benefits--not to mention an improved quality of life, which is no small factor!

Good luck!