The primary symptoms of menopause are genitourinary and vasomotor. The genitourinary syndrome of menopause (GSM) includes symptoms such as burning, irritation, dryness, dyspareunia, dysuria, and recurrent urinary tract infection. Vasomotor symptoms (VMS; hot flashes, night sweats) often disrupt sleep.

Cognitive behavioral therapy for insomnia (CBT-I) is recommended for initial treatment of chronic insomnia. CBT-I includes stimulus control, sleep education and hygiene, sleep restriction, relaxation training, and cognitive therapy. When CBT-I alone is not effective, pharmacologic treatment should be added.

Alzheimer's disease (AD) is the most common cause of dementia, but cognitive decline is also associated with other neurological conditions such as Parkinson's disease, dementia with Lewy bodies, vascular dementia, and frontotemporal dementia.

About 60% of men ≥60 years old have clinically relevant prostatic enlargement due to benign prostatic hyperplasia (BPH). The goals of treatment are to decrease lower urinary tract symptoms and to prevent disease progression and complications such as acute urinary retention. The American Urologic Association's guidelines for treatment of BPH were recently updated.

Ashwagandha is an herb extracted from the roots of an evergreen shrub (Withania somnifera) found in India that has been used as a "tonic" for centuries. No specific constituent has been identified as an active ingredient. Herbal supplements containing ashwagandha, which is also known as winter cherry and Indian ginseng, are widely promoted now in the US for treatment of pain, anxiety, stress, fatigue, sleep disturbances, cognitive decline, diabetes, arthritis, male infertility, and various cancers.

The primary symptoms of menopause are genitourinary (genitourinary syndrome of menopause; GSM) and vasomotor (VMS). Vulvovaginal atrophy can cause vaginal burning, irritation and dryness, dyspareunia, and dysuria, and increase the risk of urinary tract infections. Vasomotor symptoms ("hot flashes") cause daytime discomfort and night sweats that may disrupt sleep. Hormone therapy is the most effective treatment for both genitourinary and vasomotor symptoms.

Complete remission of symptoms is the goal of treatment for major depressive disorder; a partial response is associated with an increased risk of relapse. Improvement in symptoms can occur within the first two weeks of treatment with an antidepressant, but it may take 4-8 weeks to achieve a substantial benefit. Following successful treatment of a first major depressive episode, antidepressant treatment should be continued at the same dose for at least 4-9 months to consolidate recovery. In patients with recurrent depressive episodes, long-term maintenance treatment can reduce the risk of relapse.

Turmeric is a spice derived from the Curcuma longa plant. Dietary supplements and foods containing turmeric are widely promoted for relief of pain and to improve joint mobility, immunity, digestion, cardiovascular health, depression, anxiety, memory, and cognition.

Patients may ask about taking elderberry for prevention and treatment of influenza. Products containing elderberry are promoted for relief of cold and flu symptoms and as an immune system booster.

Alzheimer's disease (AD) is the most common cause of dementia, but cognitive loss is also associated with other neurological conditions such as Parkinson's disease, dementia with Lewy bodies, vascular dementia, and frontotemporal dementia.

The primary symptoms of menopause are genitourinary and vasomotor. A thin, dry vaginal lining and thin urethral mucosa can cause vaginal and vulvar burning and irritation, pain during intercourse, and an increased risk of urinary tract infections. Vasomotor symptoms ("hot flashes") cause daytime discomfort and night sweats that may disrupt sleep.

Pharmacological treatment of insomnia includes prescription drugs, non-prescription medications, and "natural" remedies. Behavioral approaches such as cognitive behavioral therapy, which are not discussed here, are also used. Pharmacologic treatment and behavioral therapy are often combined.

Pharmacological treatment of insomnia includes prescription drugs, non-prescription medications and "natural" remedies. Behavioral changes are often needed as well.

The primary symptoms of menopause are vasomotor and genitourinary. Vasomotor symptoms ("hot flashes") cause daytime discomfort and chronic insomnia. A thin, dry vaginal lining and thin urethral mucosa can cause vaginal and vulvar irritation, pain during intercourse, and an increased risk for urinary tract infection.

Web sites and blogs are advising patients that periodic "cleansing" of the colon is necessary to rid the body of toxins.

The FDA recently advised health care professionals and consumers not to use a number of dietary supplements found to contain the phosphodiesterase-5 inhibitor sildenafil (Viagra) or an analog of the drug (www.fda.gov). Although the effects of sildenafil may be noticeable (in men), the presence of other, possibly more toxic adulterants in dietary supplements may be more difficult or impossible to detect.

Other drugs previously found in dietary supplements have included lovastatin (Mevacor, and others), estrogen, alprazolam (Xanax, and others), indomethacin (Indocin, and others) and warfarin (Coumadin, and others). Aristolochic acid in Chinese herbal weight loss products caused acute renal failure in about 100 women in Belgium; at least 70 of them required dialysis or transplantation, and at least 18 developed urothelial cancer (Med Lett Drugs Ther 2002; 44:84).

Dietary supplements do not require FDA approval before marketing. The agency does have the power to remove mislabeled or adulterated products from store shelves, but the burden of discovery and proof is entirely on the government.

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Patients may be asking about Airborne, a dietary supplement that is being heavily promoted for prevention and treatment of colds. It contains 7 herbal extracts, 3 vitamins, 2 amino acids, selenium, zinc and many other ingredients. Airborne Jr is available for children. There are some concerns. First, there is no conclusive evidence that this product or any of its ingredients prevents colds or shortens their duration. Second, the adult tablet contains 1 g of vitamin C, and the directions for use advise taking 1 tablet at the first sign of a cold and repeating the dose every 3 hours as necessary. Vitamin C in doses higher than 1 g increases oxalate and urate excretion and may cause kidney stones (EN Taylor et al, J Am Soc Nephrol 2004; 15:3225). Third, the safety of this herbal extraction combination has not been established. And with herbs and dietary supplements in general, we only have the manufacturers' word on the label for what's in them.

Millions of people now take herbal products and other "dietary supplements." The Physicians' Desk Reference has published a PDR for Herbal Medicines listing their ingredients and indications, and the Drug Topics Red Book lists their prices.

Echinacea, a plant also called purple coneflower, is widely used as a dietary supplement for prevention and treatment of colds.

PC Spes, a dietary supplement sold for "prostate health", is being used increasingly to treat prostate cancer.