Non Hormonal Menopausal Therapy
Emily A. Bo= ohaker, MD
November 20= 07
Your patient from last week calls you
stating that she has read too many “bad” things about
estrogen. She wants to know w=
hat
her other options are to help with her hot flashes. What will you tell her?=
As discussed last week, E= strogen is the most effective treatment for decreasing vasomotor symptoms associated with menopause. Other therapies include the following:
Beha= vioral Therapies:
For = mild flushes, some women get relief with decreasing the ambient temperature.
Slow breathing which may = reduce overall sympathetic tone has been shown to modestly reduce the frequency of flushing.
There is a long pause on the phone as you are explaining this to her
and you wonder if she is still on the phone. She states that obviously you have=
never
had a hot flash and wants to know something that will really help that is n=
ot
estrogen. She then asks about
“natural” remedies. She has seen many products advertis=
ed in
health food stores that will reduce hot flashes. What do you tell her?
Unfortunately there is no convincing evidence that acupuncture, yoga, Chinese herbs, dong quai, primr= ose oil, gensing, kava, or red clover extract improve hot flashes. However, many of your patients have probably tried these before coming to see you. In one trial Vit E was found to de= crease symptoms by one hot flush per day. However, given the study showing and increase in all cause mortality= in subjects routinely taking 400 or more mg per day, I would not routinely recommend this.
A recent randomized doubl= e blind trial published in Annals (Volume 145, No 12, 2006) compared the use of bla= ck cohosh vs. soy vs. HRT vs. placebo for the treatment of vasomotor symptoms of menopause. None of the herbal remedies had cl= inically meaningful effects on vasomotor symptoms.
She has a friend that has tried soy products with great relief. She asks if she can try it. You tell her that is fine. She schedules an appointment with =
you
and says that soy worked for a while but now it is no longer working. What are her other options?
As discussed last week Ve= nlafaxine, Gabapentin, and Clonidine showed a 35%, 30% and 25% reduction in symptoms compared with placebo. You should discuss the benefits and risks of each of these therapies and help her make an informed decision.