Menopause, premenopase, perimenopause and postmenopause are all part of natural stages of life and not diseases or disorders. Therefore menopause usually does not need any treatment. If there is physical, mental or emotional effect of perimenopause and they are strong enough to significantly disrupt the everyday life of the woman experiencing them, palliative medical therapy may be required to alleviate them.

Management (menopause, premenopase, perimenopause and postmenopause) depends on many aspects such as how severe/strong are the symptoms, general health of the woman and also your preference of treatment. Treatment generally includes lifestyle modification and HRT (hormone replacement therapy). HRT can help in alleviating symptoms such as hot flashes, night sweats, mood issues, vaginal dryness etc. Women taking HRT have a low risk for stroke, heart disease, blood clots and breast cancer.

Hormone replacement therapy (HRT):

The guidelines for HRT are:

• Hormone replacement therapy is suitable for women during premenopause or who recently entered menopause.
• Hormone replacement therapy should not be used for women who are in menopause for several years.
• HRT should not be used for more than 5 years.

Estrogen in HRT has some side effects such as increased risk of endometrial cancer of uterus and need to take precautions such as using minimum effective dose, using different preparations (e.g. vaginal cream instead of a pill), regular pelvic examinations, regular Pap smear test, breast examinations etc. Addition of progesterone along with estrogen can reduce the risk of endometrial cancer.

There are other alternatives available other than hormone replacement therapy, such as use of different other medications and diet and lifestyle modifications.

Alternative medications to HRT:

They include use of antidepressants (such as paroxetin, bupropion, fluoxetine etc.), clonidine (generally used for treating high blood pressure), and seizure drug gabapentin (which can reduce hot flushes).

Diet and lifestyle modifications:

In many women perimenopausal symptoms can be reduced without used of drugs or hormone replacement therapy.

Diet changes that may help include:

• Avoid caffeine (coffee and tea), spicy foods and alcohol.
• Take diet rich in calcium (meat, fish, custard apple etc.) and vitamin D (cod liver oil, liver etc.) or take supplementations.
• Take soy foods as soy protein contains estrogen which may be helpful.

Regular exercise may also be helpful in relieving symptoms of menopause. Regular exercise is important not only for alleviating perimenopausal symptoms but also for health in general.

Other measures may be helpful, such as use of light dressing, do not give up sex and use lubricants during sex.

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