I recently had a rather disturbing incident with Nancy, a patient whom I hadn’t seen in five years. Now menopausal and newly married to Greg, she came with him to my office to get help for her diminished libido. I did not find out until after the appointment that it was Greg who prompted her to call me. I spent an hour with the two of them, discussing the ups and downs of synthetic and natural hormone replacement, homeopathy, dietary and lifestyle measures to support menopause, the various kinds of soy, natural suppositories to take care of vaginal dryness, and more. Nancy listened avidly, partly because of her extensive history of severe fibrocystic breast disease, with more than half a dozen aspiration biopsies, as well as having lost her mother to breast cancer. Much to her relief, she had experienced no problem with her breasts for the past several years. Greg seemed to want a guarantee that whatever she took would raise her sex drive.

At the end of the appointment, Nancy seemed quite enthused about trying natural progesterone cream in combination with homeopathy, but Greg continued to object that there was not enough proof that natural hormone replacement could raise libido. The rest of the information I offered apparently fell on his deaf ears. Given her susceptibility to large, painful benign breast lumps and her mother’s breast cancer, this is a woman who should be careful about estrogen replacement, yet she is clearly headed down that road for the sake of keeping her husband happy. I sincerely hope that they lead a happy life together and that she remains healthy and cancer-free, no matter how high or low her sex drive.

It is your body, your health, and your future. Do what is right for you, regardless of what anyone else thinks. You will want to consider many factors, such as your body type and baseline of bone density; what your mother’s menopausal experience was like; your risk of osteoporosis; your risk or past history of breast and uterine cancer; your predisposition to heart disease and Alzheimer’s disease; and your diet, lifestyle, and willingness to follow an ongoing program of weight-bearing exercise. It makes a lot of sense to sit down with someone knowledgeable who can help you make your decision. Since the greatest amount of bone loss occurs in the year immediately following your last period, the pros and cons of hormone replacement are something you will want to weigh even before your periods stop. In fact, you should begin taking calcium long before (preferably from the time you are a young woman) and begin a weight-training program at least by the time you enter perimenopause, preferably earlier. The choices may seem confusing, and indeed they can be, but you have the wisdom, given the right information, to make the right decision at menopause and the flexibility to change your mind later if necessary.

If you are a young woman who is considering taking hormones in any form for any reason, I encourage you, especially, to carefully consider the long-term consequences and the viable alternatives. With decades ahead of you, you will want to do everything you can to avoid osteoporosis as well as the various gynecological cancers. You may even want to consider individually formulated hormone replacement depending on your circumstances and family medical history.