Evidence-based review of therapies at the menopause. Effects of low-dose, continuous combined estradiol and noretisterone acetate on menopausal quality of life in early postmenopausal women. Hormone replacement therapy use and menopausal symptoms among women participating in a behavioral lifestyle intervention. Increase of estrogen dose deteriorates mood during progestin phase in sequential hormonal therapy. Impact of menopausal hormone-replacement therapy on clinical and laboratory characteristics of breast cancer. Relative antidepressant efficacy of venlafaxine and SSRIs: sex-age interactions. Transdermal nicotine use in postmenopausal women: does the treatment efficacy differ in women using and not using hormone replacement therapy? [Clinical effects of hormone replacement therapy with estradiol valerate and cyproterone acetate in perimenopausal women]. Hormonal and psychological treatment: therapeutic alternative for menopausal women? Prevalence of menopause symptoms and their association with lifestyle among Finnish middle-aged women. Randomized trial of osteoporosis screening. Use of hormone replacement therapy and quality-of-life results. Endometrial response to IVF hormonal manipulation: Comparative analysis of menopausal, down regulated and natural cycles Physical training and hormone replacement therapy reduce the decrease in bone mineral density in perimenopausal women: a pilot study Efficacy and safety of acupuncture for hypertension: An overview of systematic reviews. Estradiol and the addition of progesterone increase the sensitivity to a neurosteroid in postmenopausal women Effects of 5 years of hormonal replacement therapy on menopausal symptoms and blood pressure-a randomised controlled study. Comparison of Pueraria lobata with hormone replacement therapy in treating the adverse health consequences of menopause Elevated levels of sE-selectin in post-menopausal females are decreased by hormone replacement therapy to levels observed in pre-menopausal females. Effect of 1-year, low-dose DHEA therapy on climacteric symptoms and female sexuality Increased estradiol and improved sleep, but not hot flashes, predict enhanced mood during the menopausal transition. Recurrence of endometriosis in women with bilateral adnexectomy (with or without total hysterectomy) who received hormone replacement therapy. Effects of exercise training and hormone replacement therapy on lean and fat mass in postmenopausal women. Health related quality of life after combined hormone replacement therapy: randomised controlled trial Treatments for Poststroke Motor Deficits and Mood Disorders: A Systematic Review for the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Stroke Rehabilitation Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline From the American College of Physicians [Influence of hormone replacement therapy on the quality of life in postmenopausal women with hypertension]. Effects of hormone replacement therapy on cognitive performance in elderly women. Improvement in mood, physical symptoms, and function with nortriptyline for depression in patients with chronic obstructive pulmonary disease.
Background and Objective The highest level of scientific evidence available for each therapy for menopausal symptoms was sought , for example , systematic review s of r and omised controlled trials ( RCTs ) . Results There is reasonable evidence that some symptoms are modified by lifestyle , for example , cessation of smoking , exercise , reduction of alcohol , diet and alleviation of psychosocial stress . No complementary medicine , for example , phytoestrogens , black cohosh , herbal or homeopathic medicines or complementary therapies , for example , acupuncture , yoga , chiropractic manipulation , reflexology or magnetic devices have a greater effect than the usual placebo effect seen in quality blinded RCTs . Some have potential side-effects . So-called ' bioidentical hormones ' have no evidence -base and potential for harm . None of the above therapies have evidence of efficacy and long-term safety . Selective serotonin and noradrenaline re-uptake inhibitors ameliorate vasomotor symptoms and sometimes menopausal depression better than placebo . The most effective therapy for menopausal ( oestrogen ) deficiency symptoms is oestrogen which is the main component of hormone replacement therapies ( HRT ) . Compared with placebo HRT is highly effective in relieving hot flushes , night sweats , dry vagina and dyspareunia . It also improved joint pains , sexuality and sleeplessness and reduced subsequent fractures in RCTs . The increased risk of oral HRT for thromboembolism is small around menopause , for those without thrombotic risk factors , and is not elevated with non-oral routes . Cardiovascular disease may be reduced when HRT is initiated near menopause . Breast cancer risk increases after several years with the use of oral HRT containing progestogens at an annual rate of 8/10 000 ( < 0.1 % ) . No increase in breast cancer risk was seen with oestrogen-only HRT OBJECTIVES To describe the effects of low dose hormonal replacement therapy ( LD-HRT ) on quality of life in early postmenopausal women , since the postmenopausal estrogen deprivation in mid age women often brings along a series of changes and symptoms , which may greatly affect quality of life . METHODS Fifty normal postmenopausal women were recruited and r and omly treated with LD-HRT , 17beta-estradiol ( 1 mg/day ) and norethisterone acetate ( 0.5 mg/day ) ( LD-HRT ) or calcium supplement ( controls ) . No significant differences in age , age at menopause , the presence of chronic diseases and socio-economic status were present in the two groups . The Women 's Health Question naire ( WHQ ) , a vali date d quality -of-life instrument for perimenopausal and postmenopausal women , was administered at baseline and after 6 and 12 weeks of treatment in both groups . RESULTS At baseline no significant differences in WHQ scores were present in the two groups . In the control group the scores in all different areas showed no significant modification either after 6 and 12 weeks of observation . Conversely , the LD-HRT group showed a significant decrease in the scores of vasomotor symptoms , somatic symptoms , anxiety/fear , depressed mood and sleep problem items . No effects on memory/concentration and menstrual symptoms areas were evident . CONCLUSION Although quality of life is also and may be mainly influenced by socio-economic and cultural factors , LD-HRT definitively can improve not only vasomotor symptoms , but also more general aspects of physical and psychological well-being of symptomatic postmenopausal women BACKGROUND The decision to take hormone replacement therapy ( HRT ) is a choice many women encounter when entering menopause . The purpose of this study was to examine the choice to take HRT while participating in a lifestyle intervention to reduce cardiovascular risk through the menopause . METHODS The Women 's Healthy Lifestyle Project is a r and omized clinical trial design ed to examine whether a behavioral lifestyle intervention can decrease the expected rise in cardiovascular risk through the menopause . Participants ( N = 535 ) completed question naires and were interviewed regarding menopausal symptoms , menopausal status , hot flashes , and  HRT  use at baseline and 54 months . RESULTS The intervention was successful in preventing risk elevation through the 54-month visit . At the final visit , there was no difference between the intervention and control groups in the percentage who had become postmenopausal ( 32.9 % vs 35.0 % , respectively ) , there was no difference between control and intervention with  HRT  use , with 31.2 % reporting use of HRT , and there was no difference between groups with menopausal symptoms . The women started HRT an average of 6 months after they missed a period . Baseline risk factors did not predict HRT use at the 54-month visit . CONCLUSIONS A sizable number of women reported HRT use . The decision to use HRT was not influenced by the lifestyle intervention or their baseline cardiovascular risk , and these women started HRT very early in the peri- to postmenopause . Further , weight loss in the perimenopause did not affect menopausal symptoms Previous studies have indicated that the addition of progestins during sequential  hormonal replacement therapy ( HRT ) causes negative mood and physical symptoms . History of premenstrual syndrome , type of progestin , and dose of progestin have thus far been shown to influence the progestin-induced adverse mood symptoms during HRT . The aim of this study was to compare adverse mood effects of two different doses of estradiol , in combination with a progestin , during postmenopausal HRT . Twenty-eight perimenopausal women were included in this r and omized , double-blind , crossover study comparing 2- or 3-mg continuous estradiol , with an addition of 10 mg medroxyprogesterone acetate on d 17 - 28 during each treatment cycle . The main outcome measures were mood and physical symptoms kept on a daily rating scale . Together with the progestin , the higher dose of estrogen caused significantly more negative mood symptoms than the lower dose . Tension , irritability , and depressed mood were all significantly augmented during the progestin phase of cycles with 3 mg estradiol ( P < 0.001 ) . Physical symptoms also increased during the progestin phase of 3-mg estradiol cycles ( P < 0.001 ) , whereas positive mood symptoms were less affected . The only positive mood that changed with estrogen dose was friendliness , which decreased during the progestin phase of high estradiol cycles compared with cycles with lower estradiol ( P < 0.05 ) . Our conclusion is that an increase of the estrogen dose accentuates negative mood and physical symptoms during the progestin phase of sequential hormonal therapy Hormone-replacement therapy ( HRT ) is widely used by post-menopausal women . Although this treatment may slightly increase the incidence of breast cancer , more and more cases are diagnosed while women are taking HRT . The purpose of this study was to ascertain the influence of HRT on prognostic factors and outcome of breast cancer . Data on all breast-cancer patients , including precise information on HRT  , was prospect ively and systematic ally recorded in a data base . From 1985 to 1995 , 1379 post-menopausal women fulfilled the eligibility criteria for this study . All were treated by us ( P.B. and L.P. ) in our ward of a large public hospital of Marseilles , France . The clinical features , laboratory findings and survival rates in 142 HRT users who developed breast cancer while being treated were compared with those of 284 matched never user breast-cancer patients . Patients who developed breast cancer during HRT had fewer locally advanced cancers and smaller and better-differentiated cancers . Lymph-node involvement was significantly less frequent in the user group than in the non-user group ( non-significant ) . Estradiol receptivity was both qualitatively and quantitatively lower in users . There was no significant difference with regard to recurrence and metastasis-free survival and overall survival . We conclude that HRT does not affect the prognosis of breast cancer . Regular surveillance during HRT allows early detection of smaller lesions . The higher number of well-differentiated cancers and the distribution of hormone receptivity may reflect interaction between neoplastic tissue and exogenous hormones OBJECTIVE To investigate whether differences in antidepressant efficacy are moderated by an interaction of age and gender . METHODS A pooled data set from eight r and omized , controlled trials of patients with major depressive disorder ( MDD ) was reanalyzed to compare remission rates following therapy with venlafaxine  ( n = 851 ) , one of several selective serotonin reuptake inhibitors ( SSRIs )  ( n = 748 ) , or placebo  ( n = 446 ) . Remission was defined as a final Hamilton Rating Scale for Depression ( HAM-D ) score < or = 7 . Pairwise comparisons were conducted using stepwise multiple logistic regression models with main effect and interaction terms for treatment , sex , and age ( younger : < 50 ; older : > or = 50 ) . Among older women , the impact of hormone replacement therapy ( HRT ) on remission rates also was examined . RESULTS Remission rates on venlafaxine therapy were not affected by age , sex , or HRT use . Among women , but not men , there was a significant interaction reflecting poorer SSRI response in the older age group ( Wald chi-square = 4.21 , df = 1 , p = 0.04 ) ; HRT appeared to eliminate this difference . Whereas the advantage in remission rates favoring venlafaxine was modest for men and younger women ( 6%-9 % ) , the difference among older women not taking HRT was 23 % . CONCLUSIONS These findings provide further evidence that age , gender , and HRT moderate response to antidepressant medications This study of postmenopausal female smokers ( N = 94 ) asked : During short-term smoking abstinence , do the beneficial effects of transdermal nicotine replacement therapy ( NRT ) on acute symptomatology ( i.e. , withdrawal , cigarette craving , smoking urges , mood , depressive symptoms , motor speed , and reaction time ) differ in women who use and do not use hormone replacement therapy ( HRT )  ? Participants were recruited according to HRT and non-HRT use ( self- selecting ) , then r and omized within strata to active nicotine or placebo nicotine patch . After 1 baseline week of smoking , participants quit smoking for 2 weeks . Women received cessation counseling and were monitored for abstinence . Dependent measures were collected during five clinic visits . Two-way analysis of covariance ( ANCOVA ) were run on change scores for dependent variables , with nicotine patch group ( active/placebo ) and HRT group ( HRT/non-HRT ) as independent variables and age as a covariate . No interactions were found between HRT and patch condition , but both showed specific effects . During the first abstinent week , women on active nicotine patch ( compared with placebo ) experienced less severe withdrawal , greater reductions in cigarette cravings , and lower ( more favorable ) Factor 1 scores on the Question naire of Smoking Urges . During the second abstinent week , women using HRT ( compared with the non-HRT group ) exhibited better mood ( Profile of Mood States scores ) and less depression ( Beck Depression Inventory scores ) . These results suggest the following : First , the efficacy of transdermal nicotine replacement is not adversely modified by women 's HRT use ; second , ovarian hormones might influence women 's responses to smoking cessation , and thus should be considered in developing effective strategies for women to quit smoking BACKGROUND In perimenopause many women complain of psychogenic and organic disorders often connected with initial and increasing levels of hypoestrogenism . In this study we evaluated the effects of hormone replacement therapy ( HRT ) in symptomatic women in perimenopause . METHODS We enrolled 100 healthy and symptomatic women who were r and omly distributed to two groups for a 12-month study . Group A : 50 patients received HRT with estradiol valerate and cyproterone acetate ( Pausene(R ) ) ; Group B : 50 patients were used as a control group ( treated with Cacit Vitamin D30(R ) ) . A number of clinical and instrumental tests were performed at 0 , 6 and 12 months to evaluate any changes in vasomotor and urogenital symptoms , bone and serum homeostasis and possible sexual disorders . The statistical analysis was performed using the c2 test . RESULTS The group of women receiving HRT showed a significant reduction in vasomotor clinical symptoms ( p<0.001 ) and sexual disorders ( p<0.002 ) ; this was not reflected in the control group where libido decreased steadily with apparent slight improvements only at the end of the study . The urogenital disorders disappeared almost completely in Group A , whereas they diminished in Group B. HRT patients also showed a slight increase ( p<0.001 ) in the initial value of BMD ( bone mineral density ) , a reduction in the marker for bone turnover and an improved lipid profile ( p<0.05 ) . These changes were unfortunately not noted in Group B. CONCLUSIONS On the basis of these results we conclude that HRT appeared to have a beneficial effect on perimenopausal clinical symptoms over the 12-month period , leading to marked improvements in the psychophysical wellbeing of symptomatic women in perimenopause The purpose of this study was to determine whether psychological support associated with  hormone replacement therapy ( HRT )  was more beneficial than replacement therapy alone . Our findings showed that HRT alone was more effective against vasomotor symptoms than HRT with psychological treatment ( PT ) . While the combination of both treatment modalities ( HRT + PT ) was more effective against insomnia , nervousness , melancholy , fatigue , palpitations , and vertigo .  Hormonal treatment alone and HRT with psychological treatment had little effect against paresthesia or tingling . Neither HRT alone nor HRT with psychological treatment was effective against joint and muscle pain or headache BACKGROUND AND AIM OF THE STUDY The aim of this study is to report the prevalence of menopausal symptoms by severity among the Finnish female population and the association of their symptoms with lifestyle ( smoking , use of alcohol , physical activity ) and body mass index ( BMI ) . MATERIAL AND METHODS Health 2000 is a nationally representative population -based study of Finnish adults . Data were collected by home interview , three self-administered question naires and a clinical examination by a physician . This study included women aged 45 - 64 years ( n=1427 ) . All symptoms included menopause-specific symptoms . Both univariate analysis and a factor analysis based on symptom factors were performed by menopausal group . Multiple regression analysis included each symptom factor as a dependent variable and confounding and lifestyle factors ( age , education , smoking , alcohol use , physical activity , BMI , use of hormonal replacement therapy ( HRT ) and chronic disease status ) . RESULTS Over one-third ( 38 % ) of the premenopausal , half of the perimenopausal , and 54 % of both postmenopausal and hysterectomized women reported bothersome symptoms . The difference between pre- and perimenopausal women was largest and statistically most significant in the case of back pain and hot flushes . Physically active women reported fewer somatic symptoms than did women with a sedentary lifestyle . Smoking was not related to vasomotor symptoms . CONCLUSION Bothersome symptoms are common in midlife , regardless of menopausal status . Inverse association between physical activity and menopausal symptoms needs to be confirmed in r and omized trials BACKGROUND Screening perimenopausal women for low bone density has yet to be tested in a r and omized trial . The effect of screening on the use of hormone replacement therapy ( HRT ) and the subsequent quality of life in these women is unknown . The purpose of this study was to assess the effect of a screening program on HRT use of quality of life . METHODS A r and om sample of women aged 45 to 54 years and living within 32 km of Aberdeen , Scotl and , was selected from the community health index . Subjects were further r and omized to  screening or no screening using the design of Zelen . Two years after r and omization , a question naire follow-up was mailed to both groups to assess  HRT use and quality -of-life scores . RESULTS Use of HRT was higher in the screened group ( 30 % vs 24 % ; difference , 6 % ; 95 % confidence interval , 1%-11 % ; P = .02 ) . A multivariate analysis indicated that the odds of using HRT for a screened woman whose measurement for bone mineral density was in the lowest quartile was 2.54 ( 95 % confidence interval , 1.74 - 3.71 ) greater than that of an unscreened woman . Screening and subsequent HRT use did not have any detectable effects-positive or adverse-on women 's quality of life . CONCLUSION Screening for low bone density significantly increases the use of HRT in this population but without any immediate adverse or positive effects on quality of life Background Uterine luminal epithelial cell response to different hormonal strategies was examined to determine commonality when an endometrium attains a receptive , stimulated , morphological profile that may lead to successful implantation . Methods Endometrial biopsies from 3 cohorts of patients were compared . The tissue sample s taken from these patients were categorized into 8 different groups according to their baseline and the hormone regime used . Results Pre-treatment natural cycle tissue was variable in appearance . Downregulation with a GnRH analogue tissue appeared menopausal in character . HRT after downregulation result ed in tissue uniformity .  HRT in menopause result ed in a ' lush ' epithelial surface .  HST in the natural cycle improved the morphology with significant difference in secretion between the two regimes examined . Conclusions Down regulation plus HRT st and ardized surface appearance but tissue response is significantly different from the natural cycle , natural cycle plus HRT or menopause plus HRT . HRT in menopause reinstates tissue to a state similar to a natural cycle but significantly different from a natural cycle plus HST . HST with a natural cycle is similar to tissue from the natural cycle but significant differences reflect the influence of the particular hormones present ( at any point ) within the cycle The effects of physical training and hormone replacement therapy ( HRT ) on bone mineral density in perimenopausal women were studied . Sixty perimenopausal women were r and omized to either physical training ( n=20 ) , HRT ( n=20 ) , or control group ( n=20 ) . The study period was 18 months . Bone mineral density ( BMD ) in the femoral neck and lumbar spine was measured using dual-energy X-ray absorptiometry ( DXA ) . DXA was performed before treatment and after 6 and 18 months . Blood sample s for analysis of the bone markers U-deoxypyridinoline and osteocalcin were collected at the same time points . After 18 months , BMD in the spine had not decreased in either the training group or in the HRT group . In the control group , spine BMD had significantly decreased ( p=0.0014 ) . U-Deoxypyridinoline and osteocalcin were increased significantly in the control group ( p=0.0198 , p=0.0295 , respectively ) . No significant changes in bone marker levels were found in the training group or the HRT group . We found that both HRT and physical training can prevent loss of spine BMD in perimenopausal women over a period of 18 months . HRT remains a cornerstone in the treatment of vasomotor symptoms and preservation of BMD . However , HRT can only be used for limited periods of time due to the potential serious adverse effects . This study indicates a beneficial effect of physical activity on spine BMD in the perimenopausal period , and highlights its potential as an alternative to HRT during this period BACKGROUND AND PURPOSE Acupuncture is widely used in the treatment of hypertension , yet its efficacy and safety for hypertension remain controversial . This overview aim ed to summarize the evidence on acupuncture for hypertension . METHODS Eight data bases were search ed . The Assessment of Multiple Systematic Review s ( AMSTAR ) tool and the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach were performed . RESULTS Fifteen systematic review s ( SRs ) were identified . Method ological quality and quality of evidence were unsatisfactory . Acupuncture combined with Western medicine ( WM ) was superior to WM in systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) , efficacy rate , and traditional Chinese medicine ( TCM ) syndrome .  Acupuncture was more effective in treating SBP and DBP than sham acupuncture plus WM . Evidence regarding the benefit of acupuncture alone for SBP and DBP , efficacy rate and TCM syndrome was inconsistent . No serious adverse effects were identified . CONCLUSION High- quality SRs and r and omized controlled trials ( RCTs ) are required The aim of this study was to compare the pharmacodynamic response to a neuroactive steroid , pregnanolone , before and during different hormonal setting s of postmenopausal hormone replacement therapy ( HRT ) , using natural progesterone . A second aim was to investigate whether the response to pregnanolone was associated with cyclicity in negative mood symptoms during treatment . Twenty six postmenopausal women with climacteric symptoms were administered HRT in a r and omized , double blinded , placebo-controlled , crossover study . The women received 2 mg oral estradiol ( E(2 ) ) continuously during two 28-day cycles and 800 mg of vaginal progesterone or placebo sequentially for the last 14 days of each treatment cycle . Pharmacodynamic response to pregnanolone was assessed before treatment , and during the last week of each treatment cycle , by comparing the effects of intravenous pregnanolone ( 3alpha-hydroxy-5beta-pregnan-20-one ) on saccadic eye velocity ( SEV ) , saccade acceleration , saccade latency and self-rated sedation . Throughout the study daily symptom rating scales were kept . According to the daily symptom rating scales , patients were divided into two groups ; one group who displayed a significant variance in negative mood symptoms during HRT ( cyclicity ) and one group with no cyclical changes in negative mood symptoms during treatment . During treatment with either E(2 ) alone or E(2)+progesterone the response in saccadic eye movement parameters and in self-rated sedation to pregnanolone was enhanced compared to pretreatment values . The SEV , saccade acceleration and sedation responses to pregnanolone was also increased in women expressing cyclicity in negative mood symptoms compared to women with no cyclical changes in negative mood during HRT . In conclusion , during treatment with either E(2 ) alone , or E(2)+progesterone , pregnanolone  sensitivity was increased . Women expressing cyclicity in negative mood symptoms were more sensitive to pregnanolone than women without symptom cyclicity during HRT OBJECTIVES To study the effects of hormonal replacement on hot flushes , other symptoms linked to menopause , and blood pressure . METHODS The study included 1006 early postmenopausal women aged 45 - 58 years , participating in the Danish Osteoporosis Prevention Study ( DOPS ) r and omised to Hormonal replacement therapy ( HRT )  ( n=502 ) or no HRT  ( n=504 ) in an open label trial . Symptom scores were recorded at baseline , after 6 month , 1 , 2 , and 5 years on a modified Greene scale ( range 0 - 4 with 0 equalling no symptoms , and 4 maximal symptoms ) . RESULTS HRT efficiently alleviated hot flushes ( mean+/-S.E.M. score 0.48+/-0.04 in HRT vs. 0.83+/-0.05 in no HRT after 5 years , P<0.01 by repeated measures ANOVA ) , sleeping difficulties associated with hot flushes ( 0.21+/-0.60 vs. 0.37+/-0.86 , P<0.01 ) , vaginal dryness ( 0.45+/-0.04 vs. 0.73+/-0.05 , P<0.01 ) , dyspareunia ( 0.27+/-0.04 vs. 0.39+/-0.04 , P<0.01 ) , and libido ( 0.48+/-0.05 vs. 0.59+/-0.05 , P=0.08 ) . In the untreated group the occurrence of mood swings ( from 0.77+/-0.05 at baseline to 0.45+/-0.04 after 5 years , 2P<0.01 ) and oedemas ( from 0.59+/-0.04 to 0.43+/-0.04 , 2P=0.02 ) decreased with age while the occurrence of incontinence increased ( from 0.43+/-0.03 to 0.52+/-0.04 , 2P<0.01 ) . These changes were not influenced by HRT . Furthermore , HRT had no influence on presence of headache ( 0.54+/-0.05 vs. 0.58+/-0.05 after 5 years ) , voiding pattern ( 0.49+/-0.04 vs. 0.53+/-0.04 ) , or blood pressure ( mean systolic pressure 123+/-18 vs. 123+/-19 , diastolic pressure 77+/-10 vs. 77+/-11 ) . CONCLUSIONS HRT is efficient in controlling hot flushes and vaginal dryness , and symptoms related to these conditions . However , no effect on blood pressure or other menopause symptoms was recorded Objective Pueraria lobata ( PL ) is used as a traditional Chinese herbal remedy for menopausal symptoms , as well as an ingredient in preparations for conditions affecting menopausal women , such as osteoporosis , coronary heart disease , and some hormone-dependent cancers . The scientific basis for its action may be its action as a phytoestrogen . Design To examine the effects of PL in comparison with hormone replacement therapy ( HRT ) on lipid profile , sex hormone levels , bone turnover markers , and indices of cognitive function . For the study , 127 community-living , postmenopausal women aged 50 to 65 years were r and omized to receive HRT ( n = 43 ) , PL ( equivalent to 100 mg isoflavone ; n = 45 ) , or no treatment ( n = 39 ) for 3 months . The following measurements were carried out at baseline and after 3 months for all participants : menopausal symptoms question naire ; neuropsychological tests covering memory , attention , motor speed , and word-finding ability ; quality of life ( SF36 ) ; lipid profile ; urinary deoxypyridinoline ; dietary phytoestrogen intake and urinary phytoestrogen ; estradiol ; follicle-stimulating hormone ; and luteinizing hormone . Results Only participants in the HRT group showed a mean reduction in cholesterol and low-density lipoprotein cholesterol that was significantly different from that of the control group . No significant changes in lipid profile or follicle-stimulating hormone and luteinizing hormone were observed in the PL group compared with the controls . However , both the HRT and PL groups showed an improvement in Mini-Mental State Examination score and attention span compared with the case of participants receiving no treatment . HRT and PL had different effects on cognitive function ;  HRT improved delayed recall , whereas flexible thinking seemed improved in the PL group . Conclusions This study was unable to demonstrate a scientific basis for the use of PL for improving the health of postmenopausal women in general . However , the effect of PL on cognitive function deserves further study Observational epidemiological studies have shown that mortality from coronary heart disease is reduced in post-menopausal women by hormone replacement therapy ( HRT ) . The aim of this study was to measure sE-selectin levels in post-menopausal females before and after HRT  and to compare these with pre-menopausal females and aged matched males . Post-menopausal females ( n = 70 ) were given HRT or no treatment to act as a control group . sE-selectin levels were significantly lower in the pre-menopausal ( n = 36 ) when compared with the post-menopausal females ( n = 70 ) ( p = 0.027 ) , whereas no difference between two age matched male groups was found ( n = 40 ) . Oral and transdermal HRT significantly decreased sE-selectin levels ( p<0.0001 and p = 0.0005 respectively ) with no change in the control group . The reduction in the levels of this marker of endothelial activation after HRT , may reflect a decrease in leucocyte/endothelial interaction which may reduce atherosclerotic risk in post-menopausal females ABSTRACT Background Sexual desire is affected by endocrine and psychosocial factors . Menopausal hormonal changes are relevant to the causes of sexual dysfunction during reproductive aging . Aim To evaluate the effects of different types of hormonal replacement therapy ( HRT ) on sexual function , frequency of sexual intercourse , and quality of relationship in early postmenopausal women . We recruited 48 healthy postmenopausal women aged 50–60 years ( mean age 54.5 ± 3.3 years ) . Women with climacteric symptoms were uniformly r and omized into three groups receiving either dehydroepi and rosterone ( DHEA 10 mg ) daily , or daily oral estradiol ( 1 mg ) plus dihydrogesterone ( 5 mg ) , or daily oral tibolone ( 2.5 mg ) for 12 months . Women who refused hormonal therapy were treated with oral vitamin D ( 400 IU ) . Efficacy was evaluated using the McCoy Female Sexuality Question naire before treatment and after 12 months . We evaluated the hormonal profile before treatment and after 3 , 6 and 12 months . Results The groups receiving DHEA or HRT reported a significant improvement in sexual function compared to baseline ( p < 0.001 and p < 0.01 , respectively ) using the McCoy total score . The quality of relationship was similar at baseline and after 3 , 6 and 12 months of treatment . There were significant increases in the numbers of episodes of sexual intercourse in the previous 4 weeks in women treated with DHEA , HRT and tibolone in comparison with the baseline value ( p < 0.01 , p < 0.05 , p < 0.01 , respectively ) . No changes in the McCoy score occurred in women receiving vitamin D. Conclusions Daily oral DHEA therapy at the dose of 10 mg , HRT and tibolone all provided a significant improvement in comparison with vitamin D  in sexual function and in frequency of sexual intercourse in early postmenopausal women BACKGROUND The antidepressant effect of estrogen in women undergoing the menopause transition is hypothesized to be mediated by central nervous system effects of increasing estradiol on mood or through a pathway involving suppression of hot flashes and associated sleep disturbance . Estrogen therapy ( ET ) and the hypnotic agent zolpidem were selected as interventions in a three-arm , double-blind , placebo-controlled trial to distinguish the effects of estradiol , sleep , and hot flashes on depression . METHODS Women with depressive disorders , hot flashes , and sleep disturbance were r and omly assigned to transdermal 17β-estradiol 0.05 mg/d , zolpidem 10 mg/d , or placebo for 8 wk . Changes in serum estradiol , perceived sleep quality , objective ly measured sleep , and hot flashes were examined as predictors of depression improvement [ Montgomery-Åsberg Depression Rating Scale ( MADRS ) ] using multivariate linear regression . RESULTS Seventy-two peri/postmenopausal women with depression disorders were r and omized to 17β-estradiol ( n = 27 ) , zolpidem ( n = 31 ) , or placebo ( n = 14 ) . There was no significant difference between groups in depression improvement ( overall MADRS decrease 11.8 ± 8.6 ) . Increasing estradiol ( P = 0.009 ) and improved sleep quality ( P < 0.001 ) predicted improved mood in adjusted models but reduced hot flashes ( P = 0.99 ) did not . Post hoc subgroup analyses revealed that the therapeutic effect of increasing estradiol levels on mood was seen in perimenopausal ( P = 0.009 ) , but not postmenopausal , women . CONCLUSIONS For women with menopause-associated depression , improvement in depression is predicted by improved sleep , and among perimenopausal women , by increasing estradiol levels . These results suggest that changes in estradiol and sleep quality , rather than hot flashes , mediate depression during the menopause transition . Therapies targeting insomnia may be valuable in treating menopause-associated depression OBJECTIVE To estimate the risk of recurrence after administration of hormone replacement therapy ( HRT ) among women who have had endometriosis and who underwent bilateral salpingo-oophorectomy ( BSO ) .  DESIGN Prospect i ve r and omized trial ( 115 women receiving HRT and 57 not receiving HRT ) .  SETTING ; Public university hospital . PATIENT(S ) Women with a histologic diagnosis of endometriosis in whom BSO was performed ; 91.8 % had a total hysterectomy . INTERVENTION(S ) Periodical clinical examination , vaginal ultrasound , and CA-125 levels ; surgical evaluation and histologic study . MAIN OUTCOME MEASURE(S ) Recurrence rate , prognostic factors , and a mean follow-up time of 45 months . RESULT ( S ) There was no recurrence among women who did not receive HRT , versus a 3.5 % rate ( 4 out of 115 ) , or 0.9 % per year , in women who received HRT . Two recurrences required abdominal surgery . There was one additional patient who required surgery , but the relationship to the endometriosis recurrence was controversial . Among women receiving HRT , the following risk factors were detected : peritoneal involvement > 3 cm ( 2.4 % recurrence per year vs. 0.3 % ) and incomplete surgery ( 22.2 % per patient vs. 1.9 % ) . CONCLUSION ( S ) Patients with a history of endometriosis in whom total hysterectomy and bilateral salpingo-oophorectomy have been performed have a low risk of recurrence when HRT is administered . In those patients , HRT is a reasonable option . However , in cases with peritoneal involvement > 3 cm , the recurrence rate makes HRT a controversial option ; if HRT is indicated , it should be monitored closely BACKGROUND Menopause is associated with decreases in lean mass and increases in fat mass . Serum hormone levels and hormone replacement therapy ( HRT ) may modify the effects of exercise training on body composition in postmenopausal women . METHODS We assessed the changes in total body and regional lean soft tissue and fat mass ( using dual-energy x-ray absorptiometry ) in 94 sedentary postmenopausal women , aged 40 - 65 years , after 12 months of resistance and weight-bearing aerobic exercise training . Women currently on oral HRT ( n = 39 ) and not on HRT ( n = 55 ) were r and omized within groups to exercise and no exercise , result ing in four groups : exercise + HRT ( n = 20 ) , HRT ( n = 22 ) , exercise ( n = 24 ) , and control ( n = 28 ) . Fasting blood sample s were measured for resting serum total levels of estrone , estradiol , cortisol , and rostenedione , growth hormone , and insulin-like growth factor 1 at baseline and 12 months . RESULTS We found significant effects of exercise on increases in total body , arm , and leg lean soft tissue mass , and decreases in leg fat mass and percentage of body fat . There were no interaction effects of exercise and HRT on the changes in muscle strength and body composition . No significant changes in total hormone levels were found after 12 months . CONCLUSIONS Exercise training result ed in significant beneficial changes in lean soft tissue and fat mass in early postmenopausal women . These changes in body composition were neither influenced by prolonged HRT use nor accompanied by changes in total levels of the hormones determined in this study Objective To assess the effect of  combined hormone replacement therapy ( HRT )  on health related quality of life . Design R and omised placebo controlled double blind trial . Setting General practice s in United Kingdom ( 384 ) , Australia ( 94 ) , and New Zeal and ( 24 ) . Participants Postmenopausal women aged 50 - 69 at r and omisation ; 3721 women with a uterus were r and omised to combined oestrogen and progestogen  ( n=1862 ) or placebo  ( n=1859 ) . Data on health related quality of life at one year were available from 1043 and 1087 women , respectively . Interventions Conjugated equine oestrogen 0.625 mg plus medroxyprogesterone acetate 2.5/5.0 mg or matched placebo orally daily for one year . Main outcome measures Health related quality of life and psychological wellbeing as measured by the women ’s health question naire . Changes in emotional and physical menopausal symptoms as measured by a symptoms question naire and depression by the Centre for Epidemiological Studies depression scale ( CES-D ) . Overall health related quality of life and overall quality of life as measured by the European quality of life instrument ( EuroQol ) and visual analogue scale , respectively . Results After one year small but significant improvements were observed in three of nine components of the women ’s health question naire for those taking combined HRT compared with those taking placebo :  vasomotor symptoms ( P<0.001 ) , sexual functioning ( P<0.001 ) , and sleep problems ( P<0.001 ) . Significantly fewer women in the combined HRT group reported hot flushes ( P<0.001 ) , night sweats ( P<0.001 ) , aching joints and muscles ( P=0.001 ) , insomnia ( P<0.001 ) , and vaginal dryness ( P<0.001 ) than in the placebo group , but greater proportions reported breast tenderness ( P<0.001 ) or vaginal discharge ( P<0.001 ) . Hot flushes were experienced in the combined HRT and placebo groups by 30 % and 29 % at trial entry and 9 % and 25 % at one year , respectively . No significant differences in other menopausal symptoms , depression , or overall quality of life were observed at one year . Conclusions Combined HRT started many years after the menopause can improve health related quality of life . Trial registration IS RCT N 63718836 Background Early rehabilitation after stroke is essential to help reduce disability . Purpose To summarize evidence on the benefits and harms of nonpharmacologic and pharmacologic treatments for motor deficits and mood disorders in adults who have had stroke . Data Sources English- language search es of multiple electronic data bases from April 2009 through July 2018 ; targeted search es to December 2018 for studies of selective serotonin reuptake inhibitors ( SSRIs ) or serotonin-norepinephrine reuptake inhibitors . Study Selection 19 systematic review s and 37 r and omized controlled trials addressing therapies for motor deficits or mood disorders in adults with stroke . Data Extraction One investigator abstract ed the data , and quality and GRADE assessment were checked by a second investigator . Data Synthesis Most interventions ( for example , SSRIs , mental practice , mirror therapy ) did not improve motor function . High- quality evidence did not support use of fluoxetine to improve motor function . Moderate- quality evidence supported use of cardiorespiratory training to improve maximum walking speed and repetitive task training or transcranial direct current stimulation to improve activities of daily living ( ADLs ) . Low- quality evidence supported use of robotic arm training to improve ADLs . Low- quality evidence indicated that antidepressants may reduce depression , whereas the frequency and severity of antidepressant-related adverse effects was unclear . Low- quality evidence suggested that cognitive behavioral therapy and exercise , including mind-body exercise , may reduce symptoms of depression and anxiety . Limitation Studies were of poor quality , interventions and comparators were heterogeneous , and evidence on harms was scarce . Conclusion Cardiorespiratory training , repetitive task training , and transcranial direct current stimulation may improve ADLs in adults with stroke .  Cognitive behavioral therapy , exercise , and SSRIs may reduce symptoms of poststroke depression , but use of SSRIs to prevent depression or improve motor function was not supported . Primary Funding Source U.S. Department of Veterans Affairs , Veterans Health Administration Depressive disorders are a major health care issue and one of the foremost causes of disability in adults around the world , result ing in significant costs to society and health care systems ( 1 ) . The estimated economic burden associated with depression was $ 83.1 billion in 2000 and is probably higher today ( 2 ) . Depressive disorders include major depressive disorder ( MDD ) ; dysthymia ; and subsyndromal depression , including minor depression . Major depressive disorder is the most prevalent depressive disorder , with an estimated lifetime prevalence of 16 % in the United States ( 3 ) . An average of 8 million ambulatory care visits per year result in a primary diagnosis of MDD ( 4 ) . The American Psychiatric Association ( 5 ) defines MDD as depressed mood or loss of pleasure or interest along with other symptoms , including significant change in weight or appetite , insomnia or hypersomnia , psychomotor agitation or retardation nearly every day , fatigue or loss of energy , feelings of worthlessness or excessive or inappropriate guilt , indecisiveness or decreased ability to concentrate , and recurrent thoughts of death or suicide , that last for at least 2 weeks and affect normal functioning . Dysthymia is less severe , but symptoms last for 2 or more years . In contrast , subsyndromal depression is associated with less severe symptoms of depression that do not qualify for MDD or dysthymia diagnoses . The treatment of depression can be characterized by 3 phases ( Figure 1 ) : acute ( 6 to 12 weeks ) , continuation ( 4 to 9 months ) , and maintenance ( 1 year ) ( 7 ) . Relapse is defined as the return of depressive symptoms during the acute or continuation phases and is therefore considered part of the same depressive episode , whereas recurrence is defined as the return of depressive symptoms during the maintenance phase and is considered a new , distinct episode . Response to treatment ( typically defined as 50 % reduction in measured severity ) can be quantified using various tools , such as the Patient Health Question naire-9 ( PHQ-9 ) ( 7 ) or the Hamilton Depression Rating Scale ( HAM-D ) ( 8) . Figure 1 . Phases of treatment of major depression . Adapted from reference 6 . TX = treatment . Various treatment approaches can be used to manage MDD , such as psychotherapy , complementary and alternative medicine ( CAM ) , exercise , and pharmacotherapy . The psychological interventions used to treat depression include acceptance and commitment therapy , cognitive therapy , cognitive behavioral therapy ( CBT ) , interpersonal therapy , and psychodynamic therapies ( Table 1 ) . The CAM treatments include acupuncture , meditation , -3 fatty acids , S-adenosyl-l-methionine ( SAMe ) , St. John 's wort , and yoga . Exercise includes a broad range of activities that can be done for varying duration s , in classes , individually , or in informal groups . For pharmacologic therapy , the scope of this guideline is limited to second-generation antidepressants ( SGAs ) ( selective serotonin reuptake inhibitors , serotonin norepinephrine reuptake inhibitors , and selective serotonin norepinephrine reuptake inhibitors ) . First-generation antidepressants ( tricyclic antidepressants and monoamine oxidase inhibitors ) are very rarely used because SGAs have lower toxicity in overdose than first-generation antidepressants and similar efficacy . Table 1 . Common Psychological Interventions to Treat Depression Guideline Focus and Target Population The purpose of this guideline from the American College of Physicians ( ACP ) is to summarize and grade the evidence on the comparative effectiveness and safety of nonpharmacologic treatments and SGAs ( including serotonin reuptake inhibitors , serotonin norepinephrine reuptake inhibitors , bupropion , mirtazapine , nefazodone , and trazodone ) , alone or in combination , for MDD . The target audience for this guideline includes all clinicians , and the target patient population includes all adults with MDD . These recommendations are based on a background evidence article ( 9 ) and a systematic evidence review sponsored by the Agency for Healthcare Research and Quality ( AHRQ ) ( 6 ) . Methods Systematic Review of the Evidence The systematic evidence review was conducted by the AHRQ 's RTI InternationalUniversity of North Carolina at Chapel Hill Evidence -based Practice Center ( 6 ) . Additional method ological details can be found in the Appendix ) , accompanying background evidence article ( 9 ) , and full report ( 6 ) . Review ers search ed several data bases for studies published in English , German , or Italian from 1 January 1990 through September 2015 . Studies on efficacy were limited to r and omized , controlled trials and systematic review s and meta-analyses , although evidence on harms included observational studies . Review ers combined data when possible using meta- analysis and assessed the risk of bias and quality of studies according to established methods . The study population included adult out patients ( aged 18 years ) with MDD during either an initial or a second treatment attempt who did not remit after an initial adequate trial with an SGA . The review evaluated the following classes of interventions : depression-focused psychotherapy , CAM , exercise , and SGAs . Outcomes assessed included benefits in response ( often defined as 50 % improvement in HAM-D scores ) , remission ( often defined as a HAM-D score 7 ) , speed of response , speed of remission , relapse , quality of life , functional capacity ( as assessed by various scales ) , reduction of suicidality , or reduction of hospitalization . Harms assessed included overall adverse events , withdrawals because of adverse events , serious adverse events , and specific adverse events . Quality of life , functional status , suicidality , and hospitalizations were rarely reported . Grading the Evidence and Developing Recommendations This guideline was developed by the ACP Clinical Guidelines Committee according to the ACP guideline development process , which has been described ( 10 ) . The Clinical Guidelines Committee used the evidence tables in the accompanying systematic review and full report ( 9 ) when reporting the evidence and grade d the recommendations using ACP 's guideline grading system ( Table 2 ) . Table 2 . The American College of Physicians ' Guideline Grading System * Peer Review The AHRQ evidence review was sent to invited peer review ers and posted on the AHRQ Web site for public comments . The guideline was peer- review ed through the journal and was posted online for comments from ACP Governors and Regents . Comparative Benefits of Pharmacologic Versus Nonpharmacologic Treatment Options for Initial Management Refer to Appendix Table 1 and the accompanying systematic review ( 9 ) for additional details of the evidence . Appendix Table 1 . First-Line Treatment for MDD : SGAs Versus Nonpharmacologic Therapies * SGA Versus Psychological Interventions SGA Versus CBT Monotherapy . Moderate- quality evidence from 5 trials ( 1115 ) showed no difference in response when comparing SGAs ( fluoxetine , fluvoxamine , paroxetine , or sertraline ) with CBT in patients with MDD after 8 to 52 weeks of treatment . Low- quality evidence from 3 trials ( 11 , 14 , 15 ) showed no difference between remission rates ( fluoxetine , fluvoxamine , and paroxetine ) and functional capacity ( 14 ) ( fluvoxamine and paroxetine ) for SGAs compared with CBT . Combination Therapy . Low- quality evidence from 2 trials ( 14 , 16 ) showed no difference in response or remission when comparing monotherapy using SGAs ( escitalopram , fluvoxamine , or paroxetine ) with combination therapy using SGAs plus CBT ( problem-solving therapy or telephone-based CBT ) in patients with MDD after 12 to 52 weeks of treatment . Low- quality evidence from 2 trials ( 14 , 16 ) assessed function , and 1 trial showed that patients who received the combination therapy reported more improvement on 3 of 5 work-functioning measures than those who received SGA monotherapy , although clinical ly important differences on these measures are uncertain . SGA Versus Interpersonal Therapy Monotherapy . Low- quality evidence showed no difference in response ( 1 trial ; escitalopram ) ( 17 ) or remission ( 2 trials ; citalopram , escitalopram , or sertraline ) ( 17 , 18 ) for SGAs compared with interpersonal therapy for patients with MDD after 12 weeks of treatment . Combination Therapy . Low- quality evidence from 1 trial ( 19 ) showed increased remission for SGA monotherapy compared with SGA combined with interpersonal therapy ( with nefazodone ) in patients with MDD after 12 weeks of treatment . SGA Versus Psychodynamic Therapies Monotherapy . Low- quality evidence from 1 trial ( 20 ) showed no difference in remission for fluoxetine compared with psychodynamic monotherapy in patients with MDD after 16 weeks of treatment . Low- quality evidence from 2 trials ( 20 , 21 ) showed few differences in functional capacity between the treatments . Combination Therapy . Low- quality evidence from 1 trial ( 21 ) showed no difference in functional capacity for SGA monotherapy compared with SGA plus psychodynamic combination therapy . SGA Versus CAM Interventions SGA Versus Acupuncture Monotherapy . Low- quality evidence from 2 trials ( 22 , 23 ) showed no difference in treatment response when comparing fluoxetine with acupuncture monotherapy for patients with MDD after 6 weeks of treatment . Combination Therapy . Low- quality evidence from 2 trials ( 24 , 25 ) showed that combination therapy of SGAs with acupuncture improved treatment response compared with monotherapy with SGAs ( fluoxetine or paroxetine ) in patients with MDD after 6 weeks of treatment . However , low- quality evidence from 1 trial ( 24 ) showed no difference in remission when comparing paroxetine monotherapy with paroxetine plus acupuncture combination therapy . SGA Versus -3 Fatty Acids Monotherapy . Low- quality evidence from network meta- analysis showed that SGAs ( fluoxetine ) were associated with a greater response than -3 fatty acids in patients with MDD .  SGA Versus SAMe Monotherapy . Low- quality evidence from network meta- analysis showed no difference in response between treatment with escitalopram AIM The effect of hormone replacement therapy ( HRT ) on the quality of life in women with hypertension is still not clear . Thus , the aim of the study was to assess the effect of hormone replacement therapy on quality of life in postmenopausal women with essential hypertension by using a battery of st and ardized question naires . MATERIAL AND METHODS The study population consisted of 53 women ( mean age 50.9 + /- 6.3 years ) with mild and moderate essential hypertension ( mean duration 6.4 + /- 6.4 years ) . The postmenopausal status was defined as the absence of menstrual blood loss during > 6 months and blood estradiol concentration < 50 pg/ml , accompanied by follicle-stimulating hormone ( FSH ) levels > 21 U/I. Twenty seven women were blindly r and omised to transdermal hormone replacement therapy ( HRT ) and received 17-beta-estradiol and noretisterone acetate , TTS .  Twenty six women were r and omly selected as controls . The subjects were evaluated at baseline ( after 2 weeks ' wash-out from hypotensive drug period ) and after three months of HRT using self-administered st and ardized quality of life question naires : the Psychological General Well-being Index ( PGWB ) and the Subjective Symptoms Assessment Profile ( SSA-P ) . RESULTS No differences were found in blood pressure values , heart rate , body mass index and distribution of body fat tissue between women receiving HRT and controls at baseline and after 3 months of follow-up . There were no significant differences in the baseline total PGWB score as well as in its subscale between two groups . Similarly , the frequency and intensity of subjective symptoms assessed by SSA-profile were the same in both groups at baseline . After 3 months , a significant improvement in PGWB total score was observed in women receiving HRT . This effect was due to improvement in anxiety , positive well-being and vitality . Moreover , emotional distress , symptoms of flushing , sweating and trembling h and s also diminished and sexual capacity improved in women treated with HRT . CONCLUSION A three-month hormone replacement therapy in hypertensive postmenopausal women slightly improves the general well-being , seems to decrease emotional tension , increase sexual capacity and markedly relieves some vasomotor symptoms OBJECTIVE To determine the effects of 9 months of hormone replacement therapy ( HRT ) on cognitive performance in women aged 75 years and older . METHODS A 9-month r and omized , double-blinded , placebo-controlled parallel trial . Fifty-two elderly postmenopausal women ( age range 75 - 91 years ) without known contraindications to HRT or evidence of dementia or depression were enrolled . Participants were r and omly assigned in a 1:2 ratio to placebo or conjugated estrogens at 0.625 mg/d plus trimonthly medroxyprogesterone acetate at 5 mg/d for 13 days ( HRT ) . Main outcome measures were change from baseline and rate of change from baseline for the following psychometric tests : Verbal Fluency Test , Weschler Paired Associate Learning and 20 min Delayed Recall , Trailmaking A and B Tests , Cancellation R and om Letter and R and om Form Tests . RESULTS At baseline , women in the HRT group reported a younger age of onset of menopause and a higher prevalence of hysterectomy , but otherwise did not differ from women in the placebo group . After 9 months of treatment , there were no significant group differences for any of the cognitive performance measures . The lack of an observed group-by-time difference for all cognitive tests remained after controlling for age of onset of menopause , education , and previous hysterectomy . CONCLUSIONS Although conclusions are limited by small sample size and the relatively short duration of treatment , results suggest that 9 months of estrogen replacement in combination with trimonthly progestin does not improve cognitive performance in women over 75 years who do not have dementia or depression Although recent epidemiologic studies have established that patients with chronic medical illness and depressed mood are more disabled than euthymic patients , detailed data on the benefits and risks of antidepressant treatment in medically high-risk patients have been slow to accumulate . The authors have examined multiple outcome indicators in patients with disabling chronic obstructive pulmonary disease and comorbid depression . Thirty patients completed a 12-week , r and omized controlled trial of nortriptyline . Nortriptyline was clearly superior to placebo for treatment of depression . Nortriptyline treatment was accompanied by marked improvements in anxiety , certain respiratory symptoms , overall physical comfort , and day-to-day function ;  placebo effects were negligible . Physiological measures reflecting pulmonary insufficiency were generally unaffected by treatment . These data provide impetus for renewed efforts to improve recognition and treatment of mood disorders in even severely disabled medical patients
This moderate to large effect size , showing lower ratings of depressed mood in treated patients compared with controls , implicated HRT as a potential treatment of or prophylactic for depression in menopausal women .
One can generalize from the studies review ed here only with great caution , but there is little evidence to support the use of estradiol to improve mood in nondepressed patients ( not surprisingly ) and some evidence to support the antidepressant efficacy of estradiol in perimenopausal but not postmenopausal women
BACKGROUND Controversy regarding the antidepressant efficacy of hormone replacement therapy ( HRT ) stems almost from its inception and reflects the same method ological inconsistencies that have compromised efforts to determine whether the perimenopause is accompanied by an increase in mood symptoms or depression .
Since this publication , multiple studies have aim ed to discern the relationship between HRT and menopausal mood .
METHODS The purpose of this systematic review is to examine the findings and quality of the evidence amassed since Zweifel and O'Brien 's meta- analysis .