In this study, half of women aged 45 to 60 years reported experiencing menopausal symptoms. 69% of these women reported that their symptoms have negatively affected their lives. Among the women who endorsed menopausal symptoms, 72% had not received any treatment for their symptoms and 77% reported that they had not discussed treatment options with their healthcare providers.
While phytoestrogens have gained attention as possible alternatives to hormone therapy for the treatment of menopausal symptoms, placebo-controlled studies have yielded mixed results. Pomegranate seed oil is a very rich source of phytoestrogens. In this prospective randomized, placebo-controlled, double-blinded trial, 81 postmenopausal women received two daily doses of either 30 mg pomegranate seed oil (PGS) or placebo. The frequency of hot flashes decreased by 38.7% (P < 0.001) after 12 weeks of treatment with pomegranate seed oil and by 25.6% in the placebo group (P < 0.01). However, the difference between the two groups was not statistically significant (P = 0.17). The authors suggest that it may take a longer period of observation to demonstrate a difference between pomegranate seed oil and placebo.
Escitalopram, when used in the treatment of menopausal vasomotor symptoms, did not worsen overall sexual function among non-depressed midlife women.
The North American Menopause Society (NAMS) has updated its 2010 recommendations regarding the use of postmenopausal hormone therapy (HT) based on evidence accumulated subsequent to the previous report. In the decade since the first publication of the results from the Women's Health Initiative, we have accumulated evidence to indicate that multiple factors influence the effects of hormone therapy, including the type of estrogen used, the way the hormones are given, and the age and recency of menopause of the woman taking the medication. These factors also determine the risks associated with hormone therapy.
In increasing numbers, women who are candidates for hormonal replacement therapy are requesting “bioidentical” rather than synthetic hormones. Although there is a tendency to think of bioidentical hormones as “all-natural”, they, like synthetic hormones, are manufactured in the laboratory. In contrast to synthetic hormones, they are chemically identical to the hormones produced by the human body; synthetic hormones are structurally different yet are designed to have similar biological effects as naturally produced hormones.
Although estrogen is highly effective for the treatment of hot flushes, many women are reluctant to use hormone therapy to manage these symptoms, given recent concerns that estrogen may carry certain risks. Several studies have demonstrated that gabapentin (Neurontin) and certain antidepressants, including paroxetine (Paxil) and venlafaxine (Effexor), may be useful non-hormonal treatments for the management of hot flashes. Data presented at the annual meeting of the American Society of Clinical Oncology indicate that pregabalin (Lyrica), an anticonvulsant drug similar to gabapentin, may also be helpful for alleviating hot flashes.
Hot flashes and depression are both common symptoms of the menopause transition. Several studies have found a relationship between depression and hot flashes: depressed women are more likely to experience hot flashes and women with hot flashes are more likely to have depression. Other studies have found no association between hot flashes and depression.
Approximately seventy percent of all women experience hot flashes and/or night sweats (also called vasomotor symptoms) during the menopause transition (Stearns et al. 2002). Until recently, estrogen therapy was the treatment of choice for most women who sought treatment for hot flashes. Since the results of the Women's Health Initiative in 2002 noted risks of prolonged use of hormone therapy in older postmenopausal women (Roussouw et al. 2002), many women pursue other treatments for their hot flashes, including over-the-counter complementary and alternative medicines (CAMs), including soy isoflavones, black cohosh, and omega-3 fatty acids. However, there is limited evidence to support the use of these treatments for hot flashes to date.
Hot flashes are a common and distressing symptom of menopause, affecting approximately 60-70 % of women undergoing the menopausal transition. Several pharmacologic treatments for hot flashes, including hormone replacement therapy (HRT) and some antidepressants, have been shown to reduce the frequency and intensity of hot flashes. However, some women prefer not to use HRT or antidepressants and seek alternative treatments, such as homeopathic or herbal remedies. Many of these alternative treatments have not yet been evaluated for safety or efficacy.
For decades, estrogen has been used to treat menopausal symptoms, including night sweats and hot flushes. However, after studies reported that estrogen may have an adverse effect on risk for cardiovascular disease and breast cancer, many patients and clinicians have looked into alternative treatments for hot flashes, including selective serotonin reuptake inhibitors (SSRIs).
