New Report on Hot Flashes
For more than 50 years, the treatment of hot flashes
has focused primarily on estrogen therapy. However, recent studies questioning
the benefit-risk ratio of long-term estrogen and combined estrogen-progesterone
use have increased attention to and interest in alternative treatments. Assessing
the value of these treatments is often difficult as many of them have not been
studied extensively for their value in treating menopausal symptoms. In addition,
few "head-to-head" clinical trials have been done comparing the safety and efficacy
of one treatment regimen to another. How can women and their healthcare providers
sort out the information and make treatment decisions?
A big part of the answer is still trial and error.
But to help facilitate the decision-making process, the North American Menopause
Society (NAMS) has published an evidence-based Position Statement titled, "Treatment
of menopause-associated vasomotor symptoms" (Menopause, Jan. 2004).
For women who need relief from mild hot flashes,
NAMS recommends first considering lifestyle changes, such as strategies to keep
the body cool, participating in regular exercise, and using paced respiration.
These changes can be done either alone or combined with a nonprescription remedy,
such as dietary isoflavones, black cohosh, or vitamin E. Even though the published
evidence does not conclusively support the effectiveness of those remedies,
short-term use has not been shown to cause serious harm. For women with more
disturbing hot flashes as determined by their number, intensity, or the degree
to which they disrupt a woman's activities of daily living, estrogen-containing
products are still the most effective treatment. Women should know that among
estrogens, there are several different types of estrogen prescriptions, different
formulations, and different modes of administration. Prescription drug alternatives
include progestogens, the antidepressants venlafaxine, paroxetine, and fluoxetine,
as well as the anticonvulsant gabapentin may also be effective in women who
cannot or will not consider estrogen therapies.
Created: 3/5/2004  - Donnica Moore, M.D.