The task is to identify which women: 1. Have a predominance of psychological symptoms and might have psychiatric disorders. They may have presented in the clinic because they also happen to be menopausal, but it may well be that the psychiatric disorder has a quite independent aetiology. They will benefit from specific treatment for that disorder. 2. Have, and complain of, low moods or other non-specific psychological symptoms and have presented in the clinic because they are menopausal. They might benefit from practical, supportive help with current and ongoing stresses and strains. 3. Present appropriate menopausal complaints and only on enquiry reveal their psychological problems. In particular, disorders such as depressive illness, anxiety states and alcohol abuse can present with physical symptoms including ones which mimic vasomotor ones. This group may well be non-responders to HRT. Women requiring particular consideration might be those with other health problems (particularly chronic ones that might carry on in to old age) who are possibly more at risk of developing depression as they pass through the menopause. There is clearer evidence that HRT has beneficial effects on sexual function. When sexual symptoms are presented it is worth clarifying the exact features contributing to the complaint. Is it a problem of sexual interest, of infrequency of sexual activity, of vaginal dryness and dyspareunia, or is it a mixture of these complaints? Reduction of sexual interest and reduced sexual activity with the partner and possibly orgasm may accompany the menopause. Oestrogens have been shown to have some beneficial effect on sexual desire. Where oestrogen alone is ineffective, testosterone is usually beneficial. This treatment effect is particularly clear in surgically menopausal women. Non-menopausal aspects of the sexual relationship must be considered too. These aspects include the quality of the relationship, the sexual performance of the partner (since sexual desire decreases in both sexes with age), and age-related changes in self-image. These issues may need to be addressed at a simple health education level or with specific counselling. Although a woman's motivation or desire might change as a result of HRT, on its own this will not influence the frequency of intercourse or response during intercourse unless the partner variables permit this. The situation is more straightforward when problems of postmenopausal vaginal dryness and dyspareunia are the key issues. Oestrogens have been shown to be highly effective in such circumstances. It is also worth noting that regular and continued sexual activity has been found to protect against vaginal dryness.

EMOTIONAL SYMPTOMS

During menopause feelings of tension, anxiety, depression, listlessness, irritability and mood swings occur together and frequently. This occurs because the centers in the brain that control your sense of well-being, a positive state of mind and a feeling of control and tranquility are affected by the absence of oestrogen hormone. The symptoms vary from subtle sensations to severe anxiety or panic attacks. Mood swings from wild elation to deep despondency are quite common. A major depression can occur, which is predicted with the following symptoms,- Extreme eating patterns eg. Bingeing, unusual sleep patterns, being exceptionally lethargic, inability to enjoy pleasurable activities including sex, debilitating fatigue, feeling of worthlessness, difficulty in concentration and making simple decisions and thoughts of death or suicide.

Self help
Share your feelings with your partner, severe mood swings and irritability can distance you from your partner.
Join a self-help group, menopausal group, you will be in a better position to deal with depression.

INTELLECTUAL SYMPTOMS

Forgetfulness is one of the most common symptoms that menopausal women complain of, you may forget small things. The ability to concentrate also becomes difficult. These problems combined together make complex decision making and assessments difficult.

There is evidence that vitamins like B1 and B12 and minerals like calcium and potassium help improve brain health. Regular exercise and a brisk walk in fresh air also stimulates you mentally and physically.

INSOMNIA

Feeling of anxiety or depression, suffering from severe night sweats make it difficult to fall asleep, and you wake up early in the morning. Women with normal estrogen levels fall asleep faster and spend more time in deep sleep (dream stage) and wake up feeling refreshed. Without estrogen you may sleep for the whole night but may still feel very tired when you wake up.

Self help
Control your night sweats, so you sleep undisturbed.
Read a good book, and distract yourself from "you " which will help you relax better.
A glass of warm milk may help, due to the action of calcium on the nerves, avoid large heavy meals at night.
A long walk before bedtime or some aerobic exercise can improve the quality of your sleep.