Hormonal and non-hormonal interventions for menopausal symptoms

Recent cohort studies confirm that only flushes, night sweats and vaginal dryness are provenly associated with ovarian failure. Experiments nave demonstrated that these symptoms and insomnia associated with nocturnal vasomotor symptoms are more effectively controlled by oestrogen than placebo. Hormonal interventions include a variety of oestrogen or oestrogen/progestogen regimes. Non-hormonal treatments of flushes include exercise, paced respiration and psychotherapy. After the menopause vaginal atrophy and some urinary symptoms respond to local oestrogen and vaginal dryness in also prevented by lubricants. Libido is not increased by oestrogen therapy but may be improved by testosterone. Depression is common in middle-aged women but is not specifically associated with the hormonal changes occurring at the menopause. Oestrogen therapy may improve and stabilise mood during the peri-menopause but there is no firm evidence that it is effective for depression after the menopause. Arthralgia is not a symptom specific to menopause and experimental evidence concerning the role of oestrogen in the treatment of rheumatoid arthritis is inconclusive. Cognitive function is not related to menopause and measures such as stopping smoking, exercise and maintaining body weight may be partly effective in preventing menopausal symptoms.