A: You say you've been menopausal for 20 years and on hormone replacement therapy for part of that time. You still have night sweats and hot flashes, nearly every day and night. You're missing your sex drive. Your doctors have told you these symptoms may or may not stop.
I'm afraid I have to agree with your doctor: Over time, most women will have fewer and fewer bothersome symptoms of menopause, but for others the symptoms will be for life. We don't have any way to predict for whom the symptoms will resolve or when that might happen.
While lifestyle—diet and exercise—matters, it isn't the complete solution. Congratulations on losing weight and building an exercise habit! I suspect your symptoms would be worse if you hadn't lost the weight or were not exercising.
While estrogen is the most effective treatment for hot flashes, some women will benefit from other treatment options such as certain antidepressants, gabapentin, clonidine, and the herbal product Relizen. You could speak with your provider about considering a non-estrogen option.
Barb DePree, MD, has been a gynecologist for 30 years, specializing in menopause care for the past 10. Dr. DePree was named the Certified Menopause Practitioner of the Year in 2013 by the North American Menopause Society. The award particularly recognized the outreach, communication and education she does through MiddlesexMD, a website she founded and where this blog first appeared. She also is director of the Women's Midlife Services at Holland Hospital, Holland, Michigan.