In this study, half of women aged 45 to 60 years reported experiencing menopausal symptoms. 69% of these women reported that their symptoms have negatively  affected their lives. Among the women who endorsed menopausal symptoms, 72% had not received any treatment for their symptoms and 77% reported that they had not discussed treatment options with their healthcare providers.
Ever since 2002 when several large-scale studies called into question the safety of long-term hormone replacement therapy (HRT), there has been confusion and conflicting opinions regarding the management of menopausal symptoms. Initially there was a movement to avoid HRT altogether; now it is becoming clearer that certain women may safely use and benefit from hormonal interventions.
More than half of all women initiating treatment with hormone therapy will stop within the first year of treatment, most often because of side effects. Mood disturbance is a relatively common side effect that occurs with hormone therapy, and previous studies have suggested that progestins in the combined hormone preparations are responsible for these negative mood effects.
While phytoestrogens have gained attention as possible alternatives to hormone therapy for the treatment of menopausal symptoms, placebo-controlled studies have yielded mixed results. Pomegranate seed oil is a very rich source of phytoestrogens.  In this prospective randomized, placebo-controlled, double-blinded trial, 81 postmenopausal women received two daily doses of either 30 mg pomegranate seed oil (PGS) or placebo. The frequency of hot flashes decreased by 38.7% (P < 0.001) after 12 weeks of treatment with pomegranate seed oil and by 25.6% in the placebo group (P < 0.01). However, the difference between the two groups was not statistically significant (P = 0.17).  The authors suggest that it may take a longer period of observation to demonstrate a difference between pomegranate seed oil and placebo.
Menstrual problems are common among premenopausal women and become more frequent with increasing reproductive age, especially just before and during perimenopause. In the Study of Women's Health Across the Nation, a multisite study of menopause and aging, information regarding menstrual history was collected in a total of 934 premenopausal and early perimenopausal women between the ages of 42 and 52. History of major depression was associated with an increased likelihood of heavy bleeding (odds ratio, 1.89), adjusting for recent major depression, menopause status, and other confounding factors. History of depression was not associated with other abnormal bleeding or premenstrual symptoms. Future longitudinal studies are needed to explore why past depression increases the likelihood of subsequent heavy menstrual bleeding in midlife women. One possibility is that irregular fluctuations in estrogen levels may be responsible for both abnormal menstrual bleeding, as well as the dysregulation of neurotransmitter systems that mediate depressive symptoms.
Escitalopram, when used in the treatment of menopausal vasomotor symptoms, did not worsen overall sexual function among non-depressed midlife women.
The North American Menopause Society (NAMS) has updated its 2010 recommendations regarding the use of postmenopausal hormone therapy (HT) based on evidence accumulated subsequent to the previous report. In the decade since the first publication of the results from the Women's Health Initiative, we have accumulated evidence to indicate that multiple factors influence the effects of hormone therapy, including the type of estrogen used, the way the hormones are given, and the age and recency of menopause of the woman taking the medication. These factors also determine the risks associated with hormone therapy.Â
In this randomized clinical trial, 154 sedentary, symptomatic women were randomly assigned to an aerobic training or a control group. The intervention included unsupervised aerobic training for 50 minutes four times weekly for 24 weeks, whereas the control group attended health lectures twice a month. Night sweats, mood swings, and irritability were reduced more among the women in the intervention group than in the control group.
A few years ago on our blog, we reviewed a paper suggesting that estrogen may be a beneficial treatment for women with schizophrenia. Â In this study patients with schizophrenia receiving estrogen showed significant improvement in their positive symptoms (hallucinations, delusions), but no difference in negative symptoms (reduction in range of emotional expression, poverty of speech, lack of motivation).1, 2Â Â Additional studies have also found estrogen to be effective in improving positive and general symptoms in patients with schizophrenia. 3, 4
Many peri- and post-menopausal women describe problems with memory and attention. Data regarding the use of estrogen replacement therapy to improve cognitive functioning has been mixed. Furthermore, recent concerns regarding the long-term risks of ERT have limited its use. A recent report from C. Nell Epperson and colleagues from the University Of Pennsylvania School Of Medicine indicates that atomoxetine (Strattera), a treatment for attention-deficit/hyperactivity disorder (ADHD), may improve attention and reduce memory difficulties in perimenopausal and postmenopausal women.
