Counseling patients about hormones and alternatives for menopausal symptoms

Menopause typically begins in the early fifties, although the exact age of menopause will vary from woman to woman. There are several symptoms associated with menopause that can be bothersome, and prompt women to seek treatment from their primary care provider. The purpose of this review is to describe the currently available therapies, as well as the evidence that provides support for their use. The most effective therapy for menopause symptoms is hormone therapy (HT); however, while effective for menopausal symptom relief there are several potential risks to consider prior to initiating HT. Some evidence suggests that HT can increase the risk of certain types of cancers and should be avoided in women who are at high risk for ovarian cancer or breast cancer. Non-hormonal conventional therapies include selective serotonin reuptake inhibitors (SSRIs), clonidine and gabapentin. Bioidentical hormone therapy has also been shown to be effective in the relief of symptoms, but requires further research to elucidate the potential risks associated with it. Complementary and alternative (CAM) therapies include phytoestrogen, botanical and herbal treatments, acupuncture, osteopathic manipulation therapy and behavioral interventions.