Most menopausal women experience vasomotor symptoms with bothersome symptoms often lasting longer than one decade. A new review looks at the options for treatment.1
Hormone therapy (HT) represents the most effective treatment for these symptoms, with oral and transdermal estrogen formulations offering comparable efficacy, according to review coauthors Andrew Kaunitz, MD, University of Florida Research Foundation professor and associate chairman of the Department of Obstetrics and Gynecology, University of Florida College of Medicine–Jacksonville, and JoAnn Manson, MD, DrPH, NCMP, chief of the Division of Preventive Medicine at Brigham and Women’s Hospital and professor of medicine and the Bell Professor of Women’s Health, Harvard Medical School, both in Boston.
Findings from the Women’s Health Initiative and other recent randomized clinical trials have helped to clarify the benefits and risks of combination estrogen-progestin and estrogen-alone therapy, the review states. Absolute risks observed with HT tended to be small, especially in younger women, and neither regimen increased all-cause mortality rates. Given the lower rates of adverse events on HT among women close to menopause onset and at lower baseline risk of cardiovascular disease, risk stratification and personalized risk assessment appear to represent a sound strategy for optimizing the benefit-risk profile and safety of using hormone therapy for menopausal symptom treatment, the review notes.1
The North American Menopause Society (NAMS) recently published a position statement, Nonhormonal Management of Menopause-Associated Vasomotor Symptoms, on options.2 These therapies include lifestyle changes, mind-body techniques, dietary management and supplements, and prescription therapies. The costs, time, and effort involved, as well as adverse effects, lack of long-term studies, and potential interactions with medications, need to be carefully weighed against potential effectiveness during decision-making, notes the position statement.2
For the best candidates for nonhormonal treatments, look at women with contraindications to estrogen use, particularly women with a history of breast cancer or other estrogen-sensitive tumors, venous thrombosis, elevated risk of cardiovascular disease, or those women with a personal preference for avoiding hormone therapy, advises Manson. Also, women who are more than 10 years past menopause onset, especially if they are at increased risk of cardiovascular disease, might want to avoid initiation of hormone therapy, she notes.
Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis, have been shown to be effective in reducing vasomotor symptoms, according to the statement. Paroxetine salt is the only nonhormonal medication approved by FDA for the management of vasomotor symptoms; however, other selective serotonin reuptake/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine show evidence of efficacy, it notes.2
Therapies that might help alleviate symptoms include weight loss, mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but more studies of these therapies are warranted, the statement says. There are negative, insufficient, or inconclusive data for cooling techniques, avoidance of triggers, exercise, yoga, paced respiration, relaxation, over-the-counter supplements and herbal therapies, acupuncture, calibration of neural oscillations, and chiropractic interventions.2
One-third of U.S. women who take hormones at menopause are using compounded hormones, results of a new national survey indicate.3 The survey includes responses from 3,700 women ages 40-84 who were asked about their hormone use at menopause, what they thought the benefits would be, what benefits they received, and what side effects and health problems they experienced.
Survey results indicate 1,000 of the respondents had used or were using hormone therapy at menopause. Thirty-one percent of hormone therapy users were taking or had taken compounded hormones, and 34% were taking them at the time of the survey.
About 42% of the women who took compounded hormones thought that “natural” or “bioidentical” hormones are safer than other types of hormones, even though there are more than 30 tested and FDA-approved hormones for menopause, including many that are similar to human hormones.
Most of the women surveyed who used compounded or FDA-approved hormones (about 70% of each group) took them for hot flashes, which is the foremost, FDA-approved indication for menopausal hormone therapy. However, women who took compounded hormones more often expected unproven benefits that are not FDA-approved hormone therapy indications, such as to improve moodiness or irritability, sleep, low energy, depression, muscle mass, memory/concentration, sexual desire, and overall appearance, as well as to prevent aging and lose weight.
Kaunitz says that patients need to understand that compounded hormone formulations are not FDA-approved, are not standardized, with amounts of active drug varying substantially from one prescription to the next, and often are not covered by insurance.
“Fortunately, a number of FDA approved bioidentical formulations (including oral and transdermal estradiol, and oral progesterone) are available for the treatment of menopausal symptoms,” Kaunitz notes in an email to Contraceptive Technology Update.
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Kaunitz AM, Manson JE. Management of menopausal symptoms. Obstet Gynecol 2015; 126(4)859-876.
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Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause 2015; doi:10.1097/GME.0000000000000546.
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Gass ML, Stuenkel CA, Utian WH, et al. Use of compounded hormone therapy in the United States: Report of The North American Menopause Society Survey. Menopause 2015; doi:10.1097/GME.0000000000000553.
