Are there any non-hormonal alternatives to combat hot flashes?
Question:Are there any non-hormonal alternatives to combat hot flashes?
Our Response: Vasomotor symptoms (VMS) are described as a sudden onset of extreme heat in the upper body that can be associated with anxiety, heart palpitations, and sweating and chills that often are a disturbance to daily activities or sleep. Systemic hormone therapy with estradiol or estradiol in combination with progesterone is the most effective treatment for menopausal VMS. There are, however, many reasons that systemic hormone therapy may be contraindicated in postmenopausal management of VMS such as unexplained vaginal bleeding, history of estrogen-dependent breast cancer, thromboembolic disorders, or simply patient preference. Lifestyle modifications that include cooling techniques, avoidance of triggers such as alcohol, spicy or hot foods, exercise, and weight loss may be anecdotally helpful, but the randomized controlled trial (RCT) data are lacking to support benefits for VMS. Cognitive behavioral therapy and clinical hypnosis for some may be effective in reducing VMS in RCTs. Several over-the-counter supplements or herbal therapies such as black cohosh, dong quai, evening primrose oil, flaxseed, and ginseng have evidence suggesting they are unlikely to be beneficial in relieving VMS and should not be recommended. Brisdelle®, a low-dose (7.5 mg) paroxetine salt, is the only FDA-approved, non-hormonal therapy for moderate-to-severe VMS, demonstrating improvement in VMS frequency and severity without negative effects on libido or causing weight gain. Several selective serotonin reuptake inhibitors and serotonin-norepinephrine uptake inhibitors may be effective in VMS management. Gabapentin also has been shown in many trials to decrease VMS frequency and severity; it can cause drowsiness and also can be helpful with sleep if taken at bedtime. The decision on therapy options for VMS should be a shared process between the patient and the provider. It should include a thorough history, physical examination, and review of the risks/benefits and contraindications to each therapy with close follow-up for reassessment of effectiveness.
James Woods | 7/11/2019
