Hormone therapy is not the only option for managing the menopause; there are several hormone-free preparations which may be of benefit. They are, however, of limited assistance because none is able to compensate for the absence of oestrogen in the body.

Clonidine

This may reduce the frequency and severity of hot flushes. It will not correct or relieve other menopausal symptoms caused by lowered hormone levels. Caution has to be observed if cardiovascular or cerebrovascular disease or blood pressure problems are present. The dosage is 1 tablet of 50 micrograms twice daily. This dosage can be taken for three to six months before a break. However, clonidine is being used less and less as new studies indicate its effectiveness is low.

Anti-depressants and tranquillisers

The use of anti-depressants and tranquillisers requires extreme caution by both doctor and patient, because use can lead to abuse and dependency. Constant supervision is essential. These medications are by no means the only answer to menopause-related problems such as depression and stress, as will be seen. In fact, depression is not an automatic or typical symptom of the menopause, though some depressed women may become more so at this time.

Certainly the menopause can be a time of increased strain and stress and, on occasion, anxiety and depressed mood. A sympathetic family doctor can be of great assistance. Counselling and a reappraisal of ideas and ambitions may be more helpful in the long term than tranquillisers and anti-depressants.

Vitamin B6 (pyridoxine)

An increase of PMS-type symptoms in the peri-menopause may be noticed as hormone swings become more frequent, whether or not a hysterectomy has been undergone. The cyclical use of progestogens with oestrogen in HRT may worsen PMS. The swings of mood, breast discomfort and aching muscles are caused by changes in the level of brain chemical messengers which are influenced by the oestrogen/progesterone balance. Some women say they have found vitamin B6, which can be bought from most chemists and health-food shops, to be of help in this respect, though a placebo response has been thought to be quite likely.

The dosage is variable, but 25-50 mg daily is considered safe; alternatively, it may be taken only during the last two weeks of the cycle (i.e. the two weeks preceding a period). Side effects have been reported with a daily dosage of over 100 mg, but these effects are more likely to occur when the vitamin has been taken for over six months. They may take the form of sensitivity of the skin to touch, weakness of muscle groups, or skin rashes.

Gamma linolenic acid (GLA)

GLA has been found by some women to be helpful in controlling PMS symptoms. GLA is a breakdown product of cis-linoleic acid (cis-LA), an essential fatty acid of vegetable origin found particularly in sunflower, safflower and corn oils. GLA is converted in the body to protaglandins, which are able to alter body chemistry via their widespread influence upon areas such as the heart, blood vessels, intestines and arteries. Prostaglandins maintain a delicate balance with each other as well as affecting hormone relationships.

PMS is thought to be caused by hormone imbalance. It is possible, therefore, that the benefit some women perceive from taking GLA is caused by a reduction of hormone and prostaglandin imbalance as a result of GLA increasing the manufacture of prostaglandins of the E, series.

The dosage of GLA is variable: each woman must discover her own benefit level. An average dosage is a 500 mg capsule taken with food (to avoid nausea) between one and three times daily for two weeks before menstruation. Efamol (brand name) contains the seed oil of the evening primrose plant (Oenethera biennis) and supplies 72 per cent cis-LA and approximately 10 per cent GLA; it is only one of several brands of evening primrose oil on sale at health food shops and chemists.

Aci-Jel and K-Y jelly

Lack of oestrogen causes changes to the vagina; the walls become thinner, dryer and less acidic. This increase of alkalinity allows infections to occur. The application of acetic acid jelly (Aci-Jel) twice weekly, using an applicator, can be helpful.

K-Y jelly is a safe lubricant for relieving vaginal dryness and making intercourse less painful.

Skin care

Cosmetic manufacturers offer a wide range of products, many of them seductively perfumed, lavishly packaged and carrying a high price tag, which they claim will prevent skin ageing. The truth is that no cosmetic can delay, let alone prevent, the ageing of the skin. However, oestrogen can improve its collagen content, and as its water content is increased and the blood flow to it is stimulated, natural wrinkles may become less obvious.

Dry skin, which becomes more apparent as the menopause nears, can easily be improved by using a simple non-hormonal skin moisturiser. The effectiveness of such a product may bear no relationship to its cost. A few years ago, the Australian Consumers Association (ACA) published formulations for skin moisturisers. These can be made up in bulk, at home, and are as effective as, and considerably cheaper than, many of the commercial preparations; they should be kept in a refrigerator in a tightly closed container.

Reducing hot flushes

To help reduce the effects of hot flushes:

wear several layers of light clothing - preferably high in cotton content - which can be adapted to the most comfortable temperature

reduce intake of caffeine drinks and alcohol

check with the doctor that none of the medication currently being taken is likely to induce flushes

if reducing hormone therapy, do so slowly to avoid 'rebound flushes'

take frequent lukewarm showers rather than a bath

hot flushes are often worse (although not more frequent) at night: place a soft cotton towel over the lower bed sheet (ideally also cotton) to absorb excessive perspiration and reduce the need for frequent changes of bed linen.

reduce smoking (and if possible, stop completely). It is reported that the first puff of each cigarette can trigger a hot flush

try taking vitamin E, obtainable from a pharmacist or health food store, in a dosage of200-400 iu (international units) each day (take the lowest dosage level which you find helpful) to help reduce excessive sweating and flushing. It may take three or four weeks before improvement is noticed

take regular exercise, which should prove beneficial in reducing both the intensity and the frequency of hot flushes.

Herbal remedies

Many women find that some natural remedies help to relieve the hot flush symptoms of the menopause. These remedies include fenugreek, gotu kola, ginseng, sarsaparilla, liquorice root and tan kwai (also known as female ginseng). Preparations of camomile and other herbal teas may also be relaxing for women. Such herbal preparations are widely available from health food shops and some chemists.

It is important to realise that herbal remedies are just as likely as conventional drugs to cause side effects (asthmatics, for example, need to be wary of ginseng because of its histamine properties). There have been no clinical trials to substantiate the effectiveness of herbal remedies, but the placebo response may be strong enough to suggest that they may be the best choice for some women.

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Women's health