The New York Times on Tuesday examined the "dizzying array" of low-dose hormone replacement therapy options to treat menopausal symptoms that have been released since the NIH-sponsored Women's Health Initiative in 2002 found that HRT might increase a woman's risk of stroke, blood clots, breast cancer and heart attack. According to the Times, the recent release of products to treat hot flashes, night sweats, vaginal dryness and other menopausal symptoms reflects the "industry's efforts to win back" women who might be "reluctant to use traditional products."

Low-dose options for HRT include pills, patches, creams and gels, and vaginal rings or suppository tablets. FDA earlier this month approved a spray that delivers low-dose estrogen to the skin. According to the Times, low-dose HRT can be effective in treating sweating and hot flashes, but some physicians have said the lower doses might take longer than the standard doses to be effective. The current recommendation to treat menopausal symptoms is to take the lowest dose possible for the shortest amount of time, but physicians do not have proof that low doses are safer, according to the Times.

Some women have purchased from pharmacies so-called "bioidentical hormones," which are synthesized chemically but have the same structure as natural hormones, the Times reports. Supporters of bioidentical hormones say they are safer than other forms of HRT because they imitate women's hormones, but some experts said there is no conclusive evidence of greater safety.

According to the Times, hormone patches are not used widely in the U.S., but they could be a safer option for women who are concerned about high triglycerides, heart disease and blood clots because the hormones bypass the liver. Women who experience vaginal dryness and irritation might benefit from a vaginal cream, suppository tablets or a vaginal ring that releases a steady amount of hormones for several months because such products provide local relief without being absorbed into the system, the Times reports. Women who have had hysterectomies can take estrogen alone, which is associated with fewer risks than therapies that combine estrogen and progestin, Jacques Rossouw, chief of the women's health branch at the National Heart, Lung and Blood Institute, said (Rabin, New York Times, 8/28).