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Beyond Estrogen: Treatment Options for Hot Flashes.

Kelly McGarry1, Meghan Geary1, Vidya Gopinath1

  • 1Department of Internal Medicine, Alpert Medical School at Brown University, Providence, Rhode Island.

Clinical Therapeutics
|September 16, 2018
PubMed
Summary

Many women use nonhormonal treatments for hot flashes. Selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), gabapentin, and isoflavone supplements show effectiveness, while other therapies have mixed or unproven results.

Keywords:
complementary therapiescomprehensive reviewshot flash treatmentrandomized controlled trialsvasomotor symptom treatment

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Area of Science:

  • Reproductive Medicine
  • Pharmacology
  • Integrative Medicine

Background:

  • Many women seek nonhormonal treatments for bothersome hot flashes due to concerns about estrogen therapy.
  • Healthcare professionals may lack familiarity with the efficacy and safety of various alternative therapies for hot flashes.
  • Clinical trials for hot flash treatments are often limited by significant placebo effects.

Purpose of the Study:

  • To provide clinicians with an evidence-based overview of nonhormonal medications and complementary therapies for hot flash relief.
  • To summarize the effectiveness and limitations of various treatment options to guide patient care decisions.

Main Methods:

  • Review of clinical trial data for nonhormonal medications, including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and gabapentin.
  • Evaluation of evidence for complementary and alternative therapies such as isoflavone supplementation, mindfulness-based stress reduction, primrose oil, Chinese herbal medicine, acupuncture, yoga, and black cohosh.
  • Assessment of studies examining the utility of exercise, relaxation, and paced respiration for hot flash reduction.

Main Results:

  • SSRIs, SNRIs, and gabapentin demonstrate robust evidence for reducing hot flashes.
  • Isoflavone supplementation shows promising results, with effectiveness comparable to SSRIs, SNRIs, and gabapentin.
  • Mindfulness-based stress reduction therapy is also supported by evidence; black cohosh is cautioned against due to hepatotoxicity concerns, and other therapies show mixed or unproven benefits.

Conclusions:

  • Selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), gabapentin, and isoflavone supplements are effective nonhormonal options for managing hot flashes.
  • Mindfulness-based stress reduction offers a viable alternative, while therapies like black cohosh require caution.
  • Clinicians should be informed about the benefits and limitations of these diverse therapies to guide patients toward suitable treatment choices.