Self-care advice can vary depending on the symptoms being experienced:1

·       vasomotor symptoms: regular exercise, weight loss (if applicable), wearing lighter clothing, sleeping in a cooler room, reducing stress, and avoiding possible triggers (such as spicy foods, caffeine, smoking, and alcohol);

·       sleep disturbances: avoiding exercise late in the day and maintaining regular bedtimes;

·       mood and anxiety disturbances: adequate sleep, regular physical activity, and relaxation exercises;

·       cognitive symptoms: exercise and good sleep hygiene.

Other non-HRT approaches include:

·       vasomotor symptoms: a two-week trial of antidepressants (used off-label) of fluoxetine (20mg daily), citalopram (20mg daily), or venlafaxine (37.5mg twice a day);

·       vaginal dryness: a vaginal moisturiser (eg Replens MD);

·       mood disturbance, anxiety, and depression: self-help groups, cognitive behavioural therapy (CBT), or antidepressants.

Note that perimenopausal and postmenopausal women should be advised about contraception. NICE says that “a woman is considered potentially fertile for two years after her last menstrual period if she is younger than 50 years of age, and for one year if she is over 50 years of age.” HRT does not provide contraception and should not be used as contraception by women experiencing POI.1