From the Guidelines
Hormonal and nonhormonal treatment options are available for managing vasomotor symptoms, specifically hot flashes.
Treatment Options
- Hormonal treatments: Menopausal hormone therapy (MHT) is the most effective treatment for hot flashes, but its use is controversial due to associated health risks 1. MHT can be used in appropriate female cancer survivors, but alternatives should be tried first, and patients should be referred to a specialist for dosing and management. Estrogen transdermal formulations may be preferred over other formulations due to lower rates of venous thromboembolism (VTE) and stroke.
- Nonhormonal pharmacologic options: Low-dose antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can improve vasomotor symptoms 1. Anticonvulsants like gabapentin and pregabalin have also been shown to be effective in reducing hot flashes.
- Lifestyle modifications: Weight loss, quitting smoking, and limiting alcohol intake may help alleviate hot flashes 1. Cognitive behavioral therapy (CBT) and exercise/physical activity may also reduce vasomotor symptoms.
- Nonpharmacologic treatments: Acupuncture, yoga, hypnosis, and phytoestrogens, botanicals, and dietary supplements may be used to manage hot flashes, but data on their effectiveness and safety are limited or mixed 1.
It is essential to individualize treatment based on risks and consider alternative therapies if available. Patients should be referred to a specialist for dosing and management of MHT, and nonhormonal pharmacologic options should be used with caution in women taking tamoxifen due to potential interactions.
From the Research
Treatment Options for Vasomotor Symptoms
The treatment options for vasomotor symptoms, specifically hot flashes, can be categorized into several groups, including:
- Hormonal therapies: estrogens and progestogens are the most well-known effective agents in relieving hot flashes, resulting in an 80 to 90% reduction in hot flashes 2
- Nonhormonal pharmacological therapies:
- Selective serotonin reuptake inhibitors (SSRIs): paroxetine is FDA-approved for the treatment of VMSs, while fluoxetine, citalopram, escitalopram, and sertraline have also been shown to provide similar benefits 3
- Serotonin-norepinephrine reuptake inhibitors (SNRIs): venlafaxine has been well tolerated and has been shown to reduce the frequency and severity of hot flashes 3, 4, 2
- Gabapentin: an effective nonhormonal agent in reducing hot flashes 4
- Nonpharmacological interventions:
- Lifestyle modifications: proposed as the first step in the management of less severe hot flashes 4, 5, 6
- Behavioral modifications: recommended for mild hot flashes 4
- Complimentary therapies: although many have been explored, none can be recommended at this time, except for acupuncture which may warrant further investigation 4, 6
- Alternative therapies: paced respirations and hypnosis appear to be promising enough to warrant further investigation, while exercise, yoga, or relaxation techniques require further evidence to support their use 4, 6