Hot flashes, emotional highs and lows, night sweats, sluggish energy and brain fog, these are some of the symptoms of menopause — a natural biological process that marks the end of menstruation. Menopause is diagnosed after a woman has gone a year without her period. The author Margaret Atwood jokingly called it: “Menopause. A pause while you reconsider men.”

The lessening of hormones that is perimenopause often starts in a woman's 40’s or 50’s. The average age of menopause among women in the U.S. is around 51.

Some women sail through menopause experiencing few, if any, symptoms. While for others, it can disrupt their quality of life. Three-quarters of women experience hot flashes, sometimes severe enough to stop them in their tracks and may mean they carry an extra shirt to work so they can change out of damp clothing.

If a woman experiences vaginal dryness or soreness as a result of menopause, her doctor may prescribe low-dose estrogen delivered directly though vaginal absorption.

A Patient Page published recently in JAMA, the Journal of the American Medical Association, lays out the options, as well as the pros and cons of various forms of hormone therapy for bothersome menopausal symptoms.

When menopausal symptoms affect a woman’s quality of life, doctors may recommend hormone replacement of estrogen, sometimes combined with progesterone. Studies have shown that adding progesterone to estrogen may help reduce the risk of uterine cancer. But if a woman has had a hysterectomy in which her uterus has been removed, only estrogen will be prescribed.

There are a couple of options for delivery of hormone therapy. The first is through the bloodstream, either with a pill or absorbed through the skin with a patch or gel. This is known as a systemic approach. The other form of delivery is with inserts or creams. In this instance, there’s less absorption of hormones directly into the bloodstream. Most doctors will suggest the systemic approach, particularly when prescribing progesterone along with estrogen.

If your menopausal symptoms are primarily vaginal dryness or soreness or pain when urinating, your health care provider may prescribe low-dose estrogen delivered directly though vaginal absorption via an insert, tablet, cream or liquid-filled capsule. On the other hand, if your symptoms mainly involve the constriction or dilation of blood vessels resulting in problems such as night sweats or hot flashes, then studies show that systemic treatments are the way to go.

In any case, there are risks to taking hormone replacements. Estrogen, as well as a combination estrogen/progesterone therapy, have been associated with a slight risk of blood clots and breast cancer. Systemic hormone therapy has also been linked to an increase in the risk of heart disease, although more research is needed to confirm this link.

If you’ve been suffering with menopausal symptoms, discuss treatment options with your gynecologist. Why sweat it?