What do hot flashes, painful sex and thinning bones have in common?  You guessed it, menopause. As I am at that time of life, I found interesting and helpful the following three studies on just these three complaints at menopause. And, as always, I offer some personal advice.

It is not just my alarm clock set for 3:15 AM for my early morning trip from Philadelphia to Times Square for a Good Morning America segment that awakens me in what feels like the middle of the night. All too often I wake up even earlier than my alarm with a wave of heat that I have learned to recognize as those dreaded “hot flashes” associated with menopause. A sudden wave of heat travels over me that seems to start from somewhere inside my core. Regardless of the room temperature, I find myself taking off my covers and hoping it will pass. Fortunately for me and for my husband, I can quickly fall back to sleep and don’t suffer from drenching sweats. If you are not sure what a hot flash feels like, I can only assure you that women recognize them when their time comes.

Most women experience hot flashes of some kind as they approach menopause and according to popular lore, they will only last for the first year or two after their periods stop. A study of Australian women in Menopause published earlier this year however found that hot flashes continue for much longer than experts suspected, on average about 5 ½ years. So it was somewhat reassuring to learn that my patients and I were not alone!

A second study asked over 3300 women about their sex lives. The women were participating in the Study of Women’s Health Across the Nation (SWAN). Each woman answered a yearly questionnaire for 6 years straight. No surprise to me, they found that vaginal and pelvic pain complaints increased and sex drive decreased over time. Vaginal dryness was strongly linked to vaginal and pelvic pain, and as you may expect, vaginal dryness meant less emotional satisfaction and physical pleasure. Masturbation, more common in early menopause, decreased over time. But in the end, researchers found that women who enjoyed sex the most regardless of physical complaints were the women who perceived sex as important!

A final study of interest to me (did I mention I was in the throws of menopause?) was a study comparing a very low dose of an estrogen skin patch (about half the usual strength given to women to treat hot flashes) to the estrogen-blocking osteoporosis drug, Evista. Evista, a drug related to tamoxifen, is commonly given to women prevent invasive breast cancer in women at increased risk for breast cancer and to treat osteoporosis. Bone density increased for women using either medication, although women taking Evista had a slightly better result. This is good news for women such as me who have both hot flashes and concerns about bone loss. Even a tiny dose of estrogen delivered more safely through the skin can help women with hot flashes and dry vaginal symptoms, and now we know it can also help prevent bone loss. Evista, on the other hand, may help prevent bone loss, but it can actually increase hot flashes.

These three studies are reminders to women (and their practitioners) that menopause does bring a number of annoying, and sometimes more serious, concerns. Yet the good news however, for me, is that a very tiny dose of estrogen delivered through the skin can go a long way to help minimize hot flashes, prevent or treat a dry and painful vagina, and can help prevent bone loss. While it is true from the research that starting estrogen to prevent heart disease10 years or more after menopause is not a good idea, taking a small dose of hormones if you have disturbing symptoms remains the safe and single best treatment women have today.

In my book, Ask Dr Marie: Straight Talk and Reassuring Answers to Your Most Private Questions, I offer women five tips to consider before beginning hormones for menopausal symptoms. I also offer my lifestyle “pill” that every woman should take at menopause whether or not she is considering hormones. Please note: I take hormones myself — pharmaceutical grade bio-identicals approved by the FDA.

I based my personal safe and effective regimen on what I call “Dr. Marie’s Five Factors for Choosing a Menopausal Hormone (HT) Option”. Here is a brief summary:

1.      Timing. Beginning HT early during perimenopause optimizes the benefits to the heart, the bones, and cognitive function. Hormones started late in life are not good for the heart and brain.
2.      Delivery. Choose a transdermal — that is, through the skin — method rather than sending the hormones to your liver by swallowing a pill. 
3.      Low dose. The higher the dose of estrogen, the greater the risks.
4.      Periodic or “cyclic” natural progesterone. Avoid synthetic progestin’s and regimens that keep you on progesterone continuously if you still have a uterus and need this hormone to balance the effects of estrogen.
5.      Duration. Even after menopausal symptoms have subsided, some women benefit from small amounts of estrogen, often used vaginally, to treat their persistent vaginal symptoms. Each woman and her physician need to make an individual decision about how long to continue hormones.

As always, I look forward to your questions and to your comments.

To your health!

Dr. Marie
ABC News Medical Contributor

Go to the Ask Dr. Marie Home Page | Dr. Marie's Home Page

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