Assessment and treatment of hot flushes and menopausal mood disturbance

Recent reports on hormone replacement therapy (HRT) by the Women's Health Initiative (WHI) have changed the risk-benefit ratio on HRT use for millions of women. Whereas HRT was used previously for treatment of hot flushes and for prevention of cardiovascular disease and osteoporosis, the WHI reports have narrowed the primary use of HRT to menopausal symptom management. This review discusses emerging trends in the assessment and treatment of hot flushes, mood disturbance, and other neuropsychological symptoms that occur in menopausal women. Though HRT remains the mainstay of treatment for symptomatic menopausal women, alternative treatment strategies are being explored, including several major classes of psychoactive medications.