The most effective medical therapies for hot flushes are estrogen, some antidepressants, and some antiseizure medications. As a doctor, I knewdespite all the claims on social media and various wellness sitesthat diet, acupuncture, wearable magnets, and supplements were either ineffective or unproven. And on top of that, some of these so-called alternative therapies have risks. Especially supplements, which are unregulated and can sometimes contain hormones or antidepressantsmedications that shouldnt be taken without appropriate supervision.

I also practiced cognitive behavioral therapy (CBT) for hot flushes. There is good evidence to support its use here given the connection between hot flushes and anxiety; there are some shared connections in the nervous system that explain the overlap in symptoms, which may be why some medications that can treat anxiety can also improve hot flushes. Some might call that complementary or alternative medicine, but if its proven to be effectivewhich CBT isthen, for me, its just medicine.

Menopause shouldnt be a mystery.

For many womenwomen like memenopause isnt just about the bothersome symptoms. I knew my family history put me at high risk for osteoporosis. My mother began developing fractures in her 50s. She was likely in menopause by her early 40s, but such was the cloak of shame at the time that I can only approximate her age based on what I remember about her seemingly constant yelling at my father for shutting the windows.

Like many women, my mothers osteoporosis was ignored. When I suggested she get screened for osteoporosis, she was told she didnt need it. When I suggested she start hormone therapy treatment, she was told she didnt want thatand that was even before the public concern surrounding estrogen. As women age their health concerns are often ignored as women themselves are expected to fade away into oblivion. After a miserable final 10 years with fracture after fracture, she died at age 86 from osteoporosis, having spent much of those final years in pain and in hospitals.

Estrogen prevents the accelerated loss of bone mass characteristic of menopause, so I knew it was the right choice for me to treat my hot flushes and protect my bones. I opted for estradiol, which is the main type of estrogen made by the ovary before menopause. While all pharmaceutical grade MHT is low-risk, transdermal estradiol is the safest option as its not associated with an increased risk of blood clots, so thats what I chose. To protect my uterus, I chose an oral form of progesterone, as it is associated with the lowest risk of breast cancer (and even then, research shows the low risk seems to only start after several years of therapy).

Also popular are bioidentical, or compounded, hormones, but I would never recommend that approach or choose it for myself. Bioidentical is a quasi-medical term of varying definitions. These products arent one step away from ground-up yams; they are synthesized in a multistep process in a lab, as are most hormones in MHT. In other words, these terms are not medicalthey are marketing and are misleading.

There are serious safety concerns with compounded hormones. They may contain more or less hormone than advertised and their absorption may be erratic, leading to increased risks of complications such as endometrial cancer. With an FDA-approved prescription, I know exactly what Im getting and how much is absorbed. There is a wide range of dosing and formulations available, so pharmaceutical MHT can be customized to suit each woman's need. And no, I dont take money from the pharmaceutical industryI just demand precision in my medications as all women should. We deserve to know exactly what were putting into our bodies.

A womans decision to start hormones should be based on her symptoms and her risk of osteoporosis, but also her personal medical history. Its important to consider a variety of risk factors and conditions that may be positively or negatively affected by MHT, such as breast cancer, heart attack, stroke, type 2 diabetes, elevated triglycerides, blood clots, and dementia.

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Are You There God? Its Me, Menopause - Glamour