Around the time of the last menstrual period (menopause), many women start hormone replacement therapy (HRT) to relieve hot flushes/night sweats, mood swings, irritability, insomnia and a dry vagina.

Recent research has confirmed that there is a small increase in breast cancer risk when 'combined' HRT (oestrogen + progestogen) is taken longer than 5 years. However, most women require HRT for only 2 - 3 years until symptoms settle. Combined HRT taken for less than 5 years does NOT increase breast cancer risk.

Women who have had a hysterectomy and take oestrogen only (no progestogen), do not appear to be at increased risk.

2. The latest form of HRT

A new oestrogen nasal spray has recently become available and gives excellent relief from menopausal symptoms. The standard dose is one spray in each nostril once a day.

The spray is convenient to use and causes less breast tenderness than oestrogen tablets and patches. It may cause irritation in the nose and sneezing. However these reactions are mostly short-lived and mild.

3. Other treatments

Several antidepressant medications, such as paroxetine and venlafaxine, have recently been shown to effectively reduce the severity and frequency of hot flushes.

Another drug, tibolone relieves menopausal symptoms such as hot flushes and vaginal dryness. It also prevents osteoporosis and increases libido (interest in sex).

4. Natural remedies for menopause

Black cohosh is a safe and well-tolerated herbal remedy which is often effective in treating hot flushes. On the other hand, wild yam cream, progesterone cream, evening primrose oil and dong quai are not effective. The results of research into phytoestrogens is mixed and their effectiveness is uncertain. Lifestyle changes may help. Try reducing spicy food, alcohol, hot food and drinks and have regular relaxation.