(Nejm 2006;355:2338; NIH concensus development conf—Ann IM 2005;142:1003; Jama 2004;291:1621; Med Let 2004;46:98)

Sx:Age, family hx, and menstrual pattern much more helpful in making dx than FSH or Inhibin levels (Jama 2003;289:895)

Rx:

• Estrogens (Estrogen Replacement Therapy), only clear beneficial option (Ann IM 2005;142:1003), help hot flashes, osteoporosis, vaginal atrophy, and sleep. Oral or new transdermal options (Alora, Divigel, Elesrin, Evamist—Med Let 2007;49:71). Vaginally (premarin cream, Estrace cream, or Vagifem tab) biw-tiw after 1-2 wk of qd use for dyspareumia (Nejm 2006;355:2338). Contraindicated in uterine or breast cancer or men w prostate cancer on GRH antagonist rx
• Progesterone alone as pills or topically (Pro-Gest) helps hot flashes and sleep; may worsen for 1-2 d before improving in women on tamoxifen; megesterol (Megace) 20 mg po bid (Nejm 1994;331:347); or Depo-Provera 150 mg im q3mo
• Veniafaxine (Effexor) 12.5 mg po bid
• Fluoxetine (Prozac) 20 mg po qd, or paroxetine (Paxil) 12.5-25 mg po qd (Jama 2003;289:2827) or any other SSRI
• Clonidine 0.1 mg po qd helps 40% (Ann IM 2000;132:788)
• Gabapentin (Neurontin) 100 mg po hs up to 300 mg tid, reduce sx ×60% (Lancet 2005;366:818) as good as Effexor or or Paxil
• Testosterone transdermally 300 µgm/d improves sexual function significantly in post-BSOO premenopausal women (Nejm 2000;343:682)
• Alternative meds (Ann IM 2002;137:805): black cohosh and soy phytoestrogens for 3-6 mo; of questionable value (RDBCTs—Ann IM 2006;145:869 and Jama 2003;290:207)