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Conventional or Natural Pharmacotherapy and the Prevalence of Anxiety and Depression During Menopause

Dorota Kopciuch, PhD; Anna Paczkowska, PhD; Tomasz Zaprutko, PhD; Michał Michalak, PhD; Elżbieta Nowakowska

Context • Psychoneurological symptoms are present in nearly all women in the perimenopausal period. Key elements of care in the period may include hormone replacement therapy (HRT). Alternatively, phytoestrogens, antidepressant pharmacotherapy, or a combination of hormonal and antidepressant therapies may be recommended.

Objective • The study intended to verify whether women who are menopausal believe that a reduction in their symptoms of anxiety and depression depends on the type of pharmacotherapy used.

Design • The study was designed as a multicenter study, conducted in public and private, gynecological, outpatient clinics.

Setting • The study took place in public and private, gynecological, outpatient clinics in 3 regions of Poland: northwestern, central, and northern.

Participants • Potential participants were 1239 women of menopausal age who visited gynecologists at the clinics.

Outcome Measures • Participants were divided into 3 subgroups using the divisions of menopause defined by the World Health Organization, either premenopausal, perimenopausal, or postmenopausal. The study evaluated the severity of participants' menopausal symptoms using the Kupperman Index and the severity of their depression and anxiety disorders using the Hospital Anxiety and Depression Scale. A general mental health assessment was performed using a visual analogue scale, whereas the drugs used were evaluated using a Likert scale.

Results • The study found statistically significant differences between the menopausal period and the severity of the menopausal symptoms. The highest efficacy in terms of relief from menopausal symptoms, such as shortness of breath, flushing, or sweating, was observed for a combined HRT and selective serotonin reuptake inhibitor/serotonin and norepinephrine reuptake inhibitor antidepressant therapy. Nevertheless, phytoestrogen therapy was also highly effective.

Conclusions • The best method of treatment with the smallest risk of adverse effects together with a high level of patient satisfaction was found to be the phytoestrogen therapy. The women themselves believed that the therapies were effective and largely helped them to stay mentally fit.

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