Managing the menopause: An update

Vasomotor symptoms (VMS), genito-urinary syndrome of menopause (GSM), sleep disturbance, sexual dysfunction and mood disturbance are common during the menopause transition. The degree of "bother" from symptoms should guide discussions about treatment. Moderate dose estrogen-containing hormone therapy (HT) is currently the most effective treatment for VMS and also improves vaginal dryness. The indication for HT is moderate to severe VMS in women without contraindications. It should not be prescribed or continued for the treatment of chronic disease. GSM can effectively be treated with vaginal (topical) estrogens. The dose, delivery system and duration of treatment for HT should be individualised to relieve symptoms. For most healthy women aged 50-59 years, the risks of HT are low. Several widely available non-hormonal agents can treat VMS for those who should avoid or do not wish to take estrogen. These include selected antidepressants and gaba-agonists.