Management is important for women who are finding it difficult to carry on as normal, and there are several interventions that can help:

• Lifestyle changes can improve some symptoms, for example relaxation techniques such as yoga and getting plenty of rest can ease mood swings; keeping the bedroom cool at night and avoiding triggers such as caffeine, spicy food, smoking and alcohol can make a difference to hot flushes and night sweats; and eating a healthy diet and getting regular exercise can improve bone density and reduce the risk of osteoporosis
• Talking therapies, notably cognitive behaviour therapy (CBT) can help with low mood and anxiety
• Medication has a place for some. Hormone replacement therapy – which comes in a wide range of formulations from tablets and patches to gels and implants – replenishes diminishing oestrogen levels and so can ease symptoms such as hot flushes and night sweats, but can cause side effects including breast tenderness, headaches, vaginal bleeding and an increased risk of blood clots and breast cancer. Vaginal products, whether hormonal or lubricating, can help vaginal dryness
• Complementary and alternative therapies tend not to be recommended because there are questions around their effectiveness and quality, as well as the potential for interactions with other medicines that can render them unsafe.

Practice point

• A woman who has had a hysterectomy can have oestrogen-only HRT, but women who still have their uterus need to take HRT that contains both oestrogen and progesterone, have a look to find out why this is.