Beyond hormonal therapies in menopause

Women in midlife often access health care providers with reports of hot flashes, sleep problems, and depressed mood, perhaps directly or indirectly associated with menopausal hormone shifts. Evidence that stress conditions have profound effects on reproductive function is suggestive that stress adaptation is important to understanding menopausal symptoms. This paper briefly outlines salient interactions between neurohormonal mechanisms of stress responses and reproduction known to be affected by exercise, dietary intake and cognitive strategies, as a basis for advocating research that tests these therapies as alternatives or complements to drug therapies for menopausal symptoms. Reductions in hot flashes and positive mood and sleep changes are evident with such therapies but specific study in midlife women is lacking. Specifically, exercise (type, duration, intensity, and timing), dietary intake (type and amount of macronutrients or micronutrients, fiber, and timing), and cognitive techniques (type, amount, duration, and timing), deserve testing for effects on catecholamines, serotonin, opioids, and other neuromediators; ovarian hormones and related steroids, as well as gonadotropins; and circulating neuromediator precursors in midlife women. Further outcomes for testing include body weight, temperature regulation, menstrual cycle regulation, fertility, mood state, eating and sleeping patterns, social patterns, disease risk factors, and symptoms.