Lifestyle Considerations

Personal and family history can play a role in helping you to decide whether to take HRT. Here are some factors to consider:

• Family history of osteoporosis: If your ancestors are similar to you in body build and lifestyle and had problems with bone fractures from minor injuries as they aged, you may be at increased risk for bone loss and may want to consider estrogen for it bone benefits. However, ask your doctor about non-estrogen treatments first.
  
  
• Personal and family history of breast or endometrial cancer: Women with a strong family history of female tumors should talk with their doctors before taking HRT. Women with a personal history of breast or endometrial cancer will likely be advised against HRT, particularly estrogen alone, but topical or low-dose therapy may be recommended for specific conditions.
  

• Family or personal history of blood clots: It is known that HRT increases the risk of blood clots. Women with a family or personal history of blood clots should be carefully assessed by a doctor before taking HRT.

• Are you sedentary? Physical activity and exercise help develop strong bones. Sedentary women, on the other hand, have a higher risk of osteoporosis. If you can't or won't change your lifestyle, the benefits of estrogen may be great. Women who are disabled, in particular, may require the bone-protecting benefits of HRT.
  

• Do you smoke? Smokers go through menopause several years earlier than nonsmokers, increasing their risk of osteoporosis. Although HRT may protect against osteoporosis, smokers may not be able to take it due to their increased risk of developing blood clots.
  

• Are you obese? Obese women have a greater risk of breast and endometrial cancer but may have a lower risk of osteoporosis.
  

• Are you a health nut? If you eat a nutritious, varied diet, exercise regularly, and avoid items that you do not consider "natural," you may prefer not to take HRT on philosophic grounds. Fortunately, your diet and exercise regimen will help to protect you against heart disease and osteoporosis, but you may still benefit from HRT's ability to stave off bone loss.
  

• Are you stressed? Many women find that hormonal fluctuations during perimenopause lead to sleep loss, fatigue, mood swings, and irritability -- contributing factors for stress. Some women on HRT experience improved sleep and less irritability. However, HRT does not treat major depression or other significant biochemical mood disorders. Women suffering from these conditions should seek medical attention from a mental health professional.

Other issues can also play a major role in your decision to take HRT. A very busy, high-profile woman may not be able to function with sleep disruption during menopause, and she may benefit from this aspect of HRT. Some women find that their skin and hair are fuller and "younger" looking on HRT; other women find that vitamins and a healthy lifestyle accomplish the same thing. A woman who travels a lot may find bleeding an unacceptably inconvenient side effect of HRT. Other women like the bleeding, because it feels "normal" to them.

Only you can piece all these factors together for your own well-being. Above all, try to keep in mind that HRT is not a replacement for other health habits. You should decide about HRT at the same time you are working on increasing exercise, eating a healthier diet, and quitting smoking--not instead of making these vital changes. You, too, must do your part.

If you or you doctor decides that hormone replacement therapy is right for you, your next biggest decision will be what type of hormone you take. In the next section, we will help you make an informed choice.

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