The pathophysiology of menopausal symptoms
Increasing life expectancy means that most Western women will experience the menopausal transition. This phase of reproductive life involves a biopsychosocial process where the majority of women experience physiological changes, influenced by a wide range of ethnic, psychological, social and cultural factors. With relatively similar endocrine changes, symptom reporting should be generalised, yet more women in Western cultures report vasomotor symptoms (hot flushes and night sweats) compared to women in Asian cultures. Different approaches to menopause based on biological, medical, psychological or psychosocial premises result in different treatments for women who have troublesome symptoms. Hormone Replacement Therapy (HRT) is widely used in the management of symptoms associated with oestrogen withdrawal such as hot flushes, night sweats, sleep disturbance, vaginal dryness and dyspareunia, but has no known role in the treatment of midlife depression or arthritis. HRT prevents menopausal bone loss and osteoporotic fracture, though long-term use remains controversial because of the increased risk of breast cancer, myocardial infarction and stroke, as reported by the Women's Health Initiative. An understanding of the pathophysiology of menopausal symptoms and the risks and benefits of both hormonal and non-hormonal treatments assists in the individual management of patients.