From the Guidelines
Management of hot flushes and restless leg syndrome during menopause should prioritize non-hormonal approaches, given the potential risks associated with hormone replacement therapy (HRT) in certain populations, and the most recent guidelines suggest the use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) as first-line treatment for hot flushes 1.
Hot Flushes
For hot flushes, non-hormonal options include:
- Selective serotonin reuptake inhibitors like paroxetine 7.5-20mg daily or venlafaxine 37.5-150mg daily
- Gabapentin 300-900mg daily
- Lifestyle modifications such as regular exercise, avoiding caffeine and alcohol, maintaining good sleep hygiene, and practicing relaxation techniques like deep breathing or meditation
Restless Leg Syndrome
For restless leg syndrome, first address any iron deficiency with ferrous sulfate 325mg daily if ferritin is below 75 ng/mL, as suggested by the most recent guidelines 1. Medication options include:
- Gabapentin 300-1200mg at bedtime, which is a recommended treatment for restless leg syndrome in patients with end-stage renal disease (ESRD) 1 Lifestyle modifications for both conditions include:
- Regular exercise
- Avoiding caffeine and alcohol
- Maintaining good sleep hygiene
- Practicing relaxation techniques like deep breathing or meditation These symptoms occur during menopause due to fluctuating estrogen levels affecting temperature regulation centers in the brain and potentially influencing dopamine pathways involved in restless leg syndrome. Given the potential risks and benefits of different treatment options, the use of SSRIs or SNRIs for hot flushes and gabapentin for restless leg syndrome, along with lifestyle modifications, is a reasonable approach, as supported by recent guidelines 1.
From the Research
Management of Hot Flushes and Restless Leg during Menopause
- Hot flushes are a common symptom of menopause, affecting 50-85% of women older than 45 years 2.
- The exact cause of hot flushes is still debated, but it is thought to be related to the narrowing of the thermoneutral zone (TNZ) triggered by estrogen fluctuations 2.
- Hormone replacement therapy (HRT) is the standard treatment for hot flushes, but it can have life-threatening side effects and is not suitable for all women 2, 3.
- Non-hormonal treatments, such as selective serotonin and norepinephrine reuptake inhibitors, are also available and can be effective in reducing hot flushes 4, 5.
- Lifestyle modifications, such as avoiding triggers and staying cool, can also help manage hot flushes 4.
Treatment Options for Hot Flushes
- HRT with estrogen and progesterone can reduce the frequency of hot flushes by approximately 75% 5.
- Non-hormonal options, such as citalopram, desvenlafaxine, and gabapentin, can reduce the frequency of hot flushes by approximately 40-65% 5.
- Bioidentical estrogens and low-dose vaginal estrogen are also available for the treatment of hot flushes and genitourinary symptoms 5.
Restless Leg Syndrome during Menopause
- There is limited research on the management of restless leg syndrome during menopause, but it is thought to be related to hormonal changes and can be treated with lifestyle modifications and non-hormonal medications 6.
- Further research is needed to understand the relationship between restless leg syndrome and menopause, and to develop effective treatment options.
Alternatives to Estrogen for Hot Flushes
- Alternatives to estrogen, such as non-hormonal medications and lifestyle modifications, are available but may not be as effective as estrogen in reducing hot flushes 3, 6.
- The development of new, targeted, non-hormonal treatments for hot flushes is limited by the lack of understanding of the etiology and mechanisms of hot flushing 3.