The most troublesome symptoms of perimenopause and menopause are hot flushes, insomnia, depression, sexual dysfunction and cognitive decline. The suggested mechanism is the hormonal changes of estrogen, progesterone and androgen as well as neuromodulating effect of estrogen, which enhances activity of 5-HT and norepinephrine, inhibiting monoamine oxidase and dopamine. Though testosterone deficiency is not analogous to female menopause, male climacteric has become a clinical issue in current psychiatry
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