Menopausal symptoms

C,flH2o02- White crystals, m.p. 168-171 °C. Prepared from deoxyanisoin by ethylation, conversion to the alcohol, dehydration and demethylation. It is an oestrogenic substance which is highly active when administered orally. It is used for treating menopausal symptoms, for the suppression of lactation and for treatment of cancer of the prostate. 

There is much interest in the possible hormonal effects of phytoestrogens in both men and women. The majority of studies conducted in women have examined the ability of phytoestrogens to alleviate menopausal symptoms. Whilst hormone replacement therapy is recommended for women experiencing menopausal symptoms, there remains some uncertainty as to whether HRT can increase the risk of breast cancer. As a result of these concerns, investigations into natural alternatives such as phytoestrogens have received considerable attention. 

KNIGHT D c, HOWES J B, EDEN J A (1999) The effect of Promensil , an isoflavone extract, on menopausal symptoms. Climacteric. 2 79-84. 

SOMEKAWA Y, CHiGUCHi M, isHiBASHi T, Aso T (2001) Soy intake related to menopausal symptoms, serum hpids and bone mineral density in postmenopausal Japanese women. Obstet Gynecol. 97 109-15. 

Somekawa et al., 2001 Japanese peri/post-menopause n = 478 The high isoflavone intake group (65 mg/d) had significantly higher BMD of the lumbar spine compared to the low intake group (35 mg/d). Some menopausal symptoms were better alleviated in the high vs low intake group... 

WASHBURN s, BURKE G L, MORGAN T and ANTHONY M (1999). Effect of soy protein supplementation on serum hpoproteins, blood pressure and menopausal symptoms in perimenopausal women. Menopause 6 (1) 7-13. 

Recognize that alternative, non-hormonal therapies for menopausal symptoms exist and should be considered in some circumstances for women unable to take hormone-... 

CD Since the publication of the Women s Health Initiative study, there has been an increase in the use of non-hormonal therapies for the management of menopausal symptoms. Particularly for women with CHD and breast cancer risk factors, non-hormonal therapies may offer an alternative to assist with symptom management. A wide range of therapies, both prescription and herbal, have been studied with varying degrees of success. In choosing a particular therapy, it is important to match patient symptoms with a therapy that is not only effective but also safe. 

Many women seek medical treatment for the relief of menopausal symptoms, primarily hot flashes however, the role of hormone-replacement therapy (HRT) has changed dramatically over the years. HRT has long been prescribed for relief of menopausal symptoms and, until recent years, has been purported to protect women from CHD. The original reason behind recommending HRT in postmenopausal women revolved around a simple theory If the hormones lost during menopause were replaced through drug therapy, women would be protected from both menopausal symptoms and chronic diseases that often follow after a woman experiences menopause. Recent studies have disproved this theory. 

This series of trials, and many more, has led to the dramatic change in how HRT is currently prescribed and greater understanding of the associated risks. HRT, once thought of as a cure-all for menopausal symptoms, is now a therapy that should be used only to reduce the frequency and severity of vasomotor symptoms associated with menopause in women without risk factors for CHD or breast cancer. The changes that have occurred over the years in the use of HRT further support the importance of evidence-based practice and judicious medication use. 

Vasomotor symptoms, as well as other menopausal symptoms, occur in over 50% of perimenopausal women and over 80% of menopausal women.5 Menopausal symptoms tend to be more severe in women who undergo surgical menopause compared with natural menopause because of the more rapid decline in estrogen concentrations. Women who seek medical treatment should undergo laboratory evaluation to rule out other conditions that may present with similar symptoms, such as abnormal thyroid function or pituitary adenoma. Once other conditions have been excluded, HRT should be considered. 

Hormone-replacement therapy remains the most effective treatment for vasomotor symptoms and vulvovaginal atrophy and should be considered for women experiencing these symptoms. The goals of treatment are to alleviate or reduce menopausal symptoms and to improve the patient s quality of life while minimizing adverse effects of therapy. The appropriate route of administration should be chosen based on individual patient symptoms and should be continued at the lowest dose for the shortest duration consistent with treatment goals for each patient. 

HRT on the incidence of venous thromboembolism, breast cancer, or CHD. Lower-dose HRT provides women with an alternative to standard-dose HRT for menopausal symptoms but also should be recommended only for a short duration. Although many women have switched to lower-dose HRT,... 

HRT is indicated primarily for the relief of moderate to severe vasomotor symptoms. It remains the most effective treatment for vasomotor symptoms and should be considered only in women experiencing those symptoms. Women with mild vasomotor symptoms may benefit from nonpharmacologic therapy alone however, many women will seek medical treatment for these symptoms. The benefits of HRT outweigh the risks in women who do not have CHD or CHD and breast cancer risk factors however, careful consideration should be given to alternative therapies for the relief of menopausal symptoms in women with these risks. Women should be involved in the decision and may choose to use HRT despite having some risk factors owing to the severity of their symptoms. Regardless of the situation, HRT should be prescribed at the lowest dose that relieves or reduces menopausal symptoms and should be recommended only for short-term use. Women should be reassessed every 6 to 12 months, and discontinuation of therapy should be considered. 

Herbal products used for the relief of menopausal symptoms are purported to act by a number of different mechanisms. Phytoestrogens are plant sterols that are structurally similar to human and animal estrogen. Soy protein is a common source of phytoestrogens and can be found in products such as tofu, soy milk, soy flour, and tempeh. Various studies have demonstrated conflicting results as to the efficacy of... 

Overall, non-hormonal therapies are less effective in treating vasomotor symptoms than HRT but do offer an important option for women experiencing menopausal symptoms who cannot or are unwilling to take HRT. The antidepressants gabapentin and clonidine have the best evidence for efficacy of all the non-hormonal options and should be considered first as an alternative to HRT. The most important considerations in choosing an alternative therapy are the patient s comorbidities and the efficacy and safety of the medication. 

LHRH Analogs Goserelin Leuprolide Triptorelin 3.6 mg SC every 28 days 7.5 mg IM every 28 days 3.75 mg IM every 28 days Hot flashes, amenorrhea, menopausal symptoms, injection site reactions... 

Mahady GB. Black cohosh (Cimicifuga racemosa) review of the clinical data for safety and efficacy in menopausal symptoms. Treat Endocrinol 2005 4 177-184. 

Note, a. Defined as drugs that make one feel better rather than just well, for example, drugs for treating impotence, high lipids or menopause symptoms, and contraceptives. 

---