Alternatives to hormone therapy for management of climacteric syndrome

The “gold” standard of treatment for women with menopausal syndrome (MS) is hormonal therapy, which, however, may not be acceptable in all cases, which determines the need to choose other methods. Effective alternatives to the treatment of MS are tissue-selective modulators of estrogen receptors and phytoestrogens, which contribute to the reduction of both early (vegetative-vascular and psycho-emotional) and mid-term and late disorders (osteoporosis), in contrast to selective serotonin reuptake inhibitors and serotonin / norepinephrine, which affect only the vegetative-vascular and psychoemotional symptoms and bisforphonates, which prevent the loss of bone mineral density. Isoflavones of red clover at a dose of 40 mg when taken for 3 months lead to a reduction in hot flashes in 47-85% of patients, insomnia in 53%, anxiety and depression in 76-81%, and also has a positive effect on endocrine-metabolic disorders and bone mineral density with prolonged use. Their use has been shown to be safe for 3 years. Controlling stress through cognitive behavioral therapy (positive effects on psychological symptoms, stress and depression) and clinical hypnosis (reducing symptoms by 50%) may be helpful in relieving MS symptoms. Supplements with vitamins C, D, K and calcium can be recommended to maintain healthy bones, antioxidants (vitamins C and E) - to enhance the effects of pharmacotherapy. There is no evidence of benefits for vasomotor symptoms of yoga, breathing exercises, relaxation, herbal and homeopathic remedies, nutritional supplements. The information accumulated to date on the efficacy and safety of phytoestrogens (red clover extract) makes it possible to recommend them as an alternative to MHT for the treatment of disorders associated with involutive changes in the female reproductive system during the peri- and postmenopausal period.