• Offer lifestyle advice to control symptoms; if this is not effective, consider other treatments.
• For vasomotor symptoms, consider:
• A trial (2 weeks) of paroxetine (20 mg daily), fluoxetine (20 mg daily), citalopram (20 mg daily), or venlafaxine 37.5 mg twice a day (unlicensed).
• A trial (2–4 weeks) of clonidine 50 to 75 micrograms twice a day (licensed use).
• A progestogen such as norethisterone or megestrol (both unlicensed). Seek specialist advice.
• For vaginal dryness, prescribe a vaginal lubricant or moisturizer, such as Replens MD^®.
• Manage psychological symptoms, such as mood disturbances, anxiety, and depression on an individual basis. They may be addressed using self-help groups, psychotherapy, other forms of counselling, or antidepressants.
• CKS does not recommend the use of complementary therapies (e.g. soy, red clover, black cohosh).

In depth

• Advise the woman to return if:
• Lifestyle measures alone have been of insufficient benefit or her symptoms have worsened.
• She does not respond to antidepressant treatment within 2 weeks.
• Clonidine was started and her symptoms have not improved in 4 weeks, or she is experiencing adverse effects, such as dizziness or constipation.
• Review all women at least annually.

In depth

• Consider stopping treatment if a woman is symptom-free on treatment; a trial withdrawal can be undertaken after 1–2 years of treatment.
• Advise that symptoms sometimes recur once treatment is stopped.
• Use of vaginal moisturizers and lubricants may be continued indefinitely.

In depth