There is a great deal of information available – how can we distinguish between the trustworthy and quackery? Evidence is key. In the UK the National Institute for Health and Care Excellence (NICE) exists to improve health and social care through evidence-based guidance for both healthcare professionals and the public. What guidance does NICE provide?
NICE NG23 advises that during perimenopause you might have symptoms such as hot flushes, night sweats, joint and muscle pain, vaginal dryness, mood changes and a lack of interest in sex. Menopause affects every woman differently. You may have no symptoms at all, or they might be brief and short‑lived. For some women they are severe and distressing. For women who seek help for their menopausal symptoms, HRT (hormone replacement therapy) is the most commonly prescribed treatment. NG23 also identifies non-hormonal prescription treatments, for example a drug called clonidine other types of treatments, such as cognitive behavioural therapy (CBT), a type of psychological therapy that helps people to manage the way they think and feel. Finally NG23 recognises that you can get many different treatments for menopausal symptoms without a prescription. Some women find that complementary therapies help. If you wish to try these, your GP should explain that their quality and ingredients may be unknown. NG23 notes that low mood is a common symptom of menopause [however] it has not been shown that antidepressant drugs called SSRIs and SNRIs can help with low mood during menopause if you haven’t been diagnosed with depression.
According to a 2017 British Medical Journal article Non-hormonal treatments for menopausal symptoms (BMJ 2017;359:j5101) Menopause is a normal event, and most women do not seek medical intervention. Of those who do, some will require only information and advice, but around 25% have problematic symptoms that may need treatment. [Hot flushes and/or night sweats] are the main reason that women seek treatment. Hormone replacement therapy is effective for vasomotor symptoms, but for some it is unsuitable (due to preference or contraindications) and non-hormonal treatments can be considered.
[Hot flushes and/or night sweats] affect about 80% of women, with around 25% reporting problematic symptoms that affect quality of life. Vasomotor symptoms usually occur daily and may continue for 4-10 years with a peak in the year around the final menstrual period. Vaginal symptoms (dryness and/or dyspareunia) affect around a third of women and tend to persist until older age (age 80 years) or may appear some years after the menopause. Around a third of women experience sleep disturbance during the menopause transition, and an estimated 10% have depressive symptoms, which tend to resolve in the postmenopause and may be associated with psychosocial factors. Ethnicity may affect the nature and severity of symptoms, and menopausal symptoms may differ for premature or early menopause or following chemotherapy, oophorectomy, or anti-oestrogen treatments.