Menopausal symptoms and the domino effect

It has been argued that if hormone replacement therapy (HRT) improves mood, this would indicate a relationship between hormone change and mood change. The most common physical symptoms in peri-menopausal women are vasomotor symptoms. These are alleviated by HRT, and improvement in mood could be a secondary effect of the improvement in vasomotor symptoms who were known as the domino effect. A small study of HRT in women with no vasomotor symptoms prescribed HRT for protection against cardiovascular disease and osteoporosis was carried out to investigate the effect on mood. Twelve women were assessed at baseline and 6, 12 and 24 weeks after starting HRT. They were assessed on the IDA and CRS scales. There were no significant changes from baseline and no change in scores over time. Four women were depressed and two improved. The results do not support the direct effect hypothesis but a randomized controlled trial of HRT on asymptomatic women is needed.