Emotional well-being, sexual behaviour and hormone replacement therapy.

Improvements in the design of epidemiological studies of the climacteric and postmenopause have been made in the past 25 years. But more complex theoretical models are necessary if we are to give due emphasis to the influence of psychological, social, cultural and hormonal factors and their interactions. The majority of studies show that emotional problems are not more prevalent during the climacteric and postmenopause and that psychosocial factors, such as stressful life-events, are more likely causes of emotional distress during mid-life. Vaginal dryness increases in postmenopausal women but there are varied reasons for changes in other aspects of sexual behaviour which require further research. While estrogen may have a "mental tonic" effect when prescribed in high doses, HRT does not appear to have a significant effect upon mood or sexual behaviour over and above placebo effects and the relief from vasomotor and vaginal symptoms.