Pharmacological care of women around menopause

Vasomotor symptoms ,vaginal atrophy ,osteoporosis and depression are the most common menopausal symptoms that may seeks for medical care. Hormone therapy is currently the only FDA-approved treatment for hot flashes. Current recommendations are to use the lowest dose of hormone therapy for the shortest period that will allow treatment goals to be met. Alternative treatments include :serotonin reuptake inhibitors,gabapentin 900mg\d and clonidine 100-150mcg\d still under investigation and need more clinical trials to be approved from FDA.Vaginal atrophy associated with decreased estrogen levels may be treated with an estradiol vaginal ring that can be left in the place for 3 months and it is suitable for long term use with minimal systemic absorption. Vaginal cream therapy will relieve the vaginal atrophy but the variable absorption may limit its use. If estrogen is contraindicated testosterone propionate 1-2% in vanishing cream seems to be effective. Depression across the menopause has a multifactorial etiology and seems to be resistant to treat with antidepressant alone. The combination of the antidepressant with hormonal therapy seems to offer the best therapeutic potential in terms of efficacy, rapidity of improvement and consistency of remission in the follow-up.Osteoporosis and osteoporotic bone fractures becomes a serious life threat for women after menopause. Treatment with selective estrogen receptor modulator (SERM) ,hormone replacement therapy (HRT),and bisphosphonates improve bone turnover increased in postmenopausal women to normal range before menopause. A limited number of clinical trials have been conducted with nonprescription remedies, including paced respiration, yoga, acupuncture, exercise, homeopathy and magnet therapy, and some, but not all of these, have been found to be more effective than placebo. Dietary herbal supplements, such as soy and black cohosh, have demonstrated some effects in placebo-controlled trials.