ALTERNATIVES OF MENOPAUSAL HORMONE THERAPY.

INTRODUCTION: It has been generally accepted that the benefits of menopausal hormone therapy outweigh the risks. but there are still some concerns about the administration of menopausal hormone therapy, which has introduced alternative treatments. Pharmacological Alternatives. Central alpha-2 agonist clonidine is only marginally more effective than placebo, and significantly less effective than estrogen. Antiepileptic drug gabapentin reduces hot flashes; however, it is less effective than estrogen. Selective serotonin reuptake inhibitors (paroxetine and fluoxetine) and selective noradrenaline reuptake inhibitors (venlafaxine) reduce vasomotor symptoms and improve depression, anxiety and sleep. Results of studies about dehydroepiandrosterone effects on menopausal symptoms are inconsistent and additional investigations are needed. Non-Pharmacological Alternatives. Stellatum ganglion blockade is a successful treatment for reducing vasomotor symptoms in patients with contraindications for menopausal hormone therapy. Efficacy of acupuncture, homeopathy and reflexology Should be proved by adequate studies. Phytoestrogens could reduce vasomotortymptoms but to a lesser extent than conventional menopausal hormone therapy. However, they have not been proved yet to pro-ide cardiovascular protection and prevention of osteoporosis. nor they could be recommended instead of traditional menopausal hor-one therapy. There is a concern about their undesirable effects. Adequate diet, unchanging body weight Nwthin ideal values and adequate physical activities have beneficial long-term effects, first of all onlpreservation of bone density Alternatives for Atrophic Changes of Vaginal Epithelium. Menopausal symptoms resulting from vaginal atrophy could be resolved by use of hydrophilic prep- arations, lubricants and topical lidocaine creamn r 4% lidocaine water solution for dyspareunia.

CONCLUSION: If there are contrain-ications to menopausal hormone therapy or patients are unwilling to take hormone therapy, alternative treatments, which canlalso solve menopausal symptoms, should be considered.