A recent paper from the European Menopause and Andropause Society (EMAS) reviews non-hormonal therapy options for the treatment of  menopausal vasomotor symptoms. This EMAS position paper provides guidance for treaters managing peri- and postmenopausal women who cannot or do not want to use hormones to manage their symptoms.  While the information here is not new, it does highlight what we have seen — that many commonly used non-pharmacologic treatments and supplements are not particularly effective.

Exercise: Insufficient or conflicting data, but authors note that it could improve overall quality of life and decrease risk of heart disease.

Cognitive Therapy: Data is limited.

Acupuncture:  Data is limited.

Supplements and Phytoestrogens (including soy products): Either minimal or no benefit.

Selective serotonin-reuptake inhibitors (SSRIs) and serotonin norepinephrine-reuptake inhibitors (SNRIs):  Effective for decreasing both the frequency and severity of hot flashes. Only paroxetine (Brisdelle) is approved by the FDA for this indication; however, other SSRIs and SNRIs are also effective.

Gabapentin (Neurontin): Effective.

The authors suggest that while many of the alternative treatments studied were ineffecitve, they carry minimal risk and few side effects.  Thus, women may consider trying some of the non-pharmacologic options first. This makes sense; however, we must keep in mind the significant impact of menopausal symptoms on quality of life.  We must educate women and their treaters that while some alternative treatments may not work,  there are highly effective and well-tolerated non-hormonal strategies for managing menopausal symptoms.

Ruta Nonacs, MD PhD

Alternative therapies for hot flashes are hit or miss (Reuters Health)

Mintziori G, Lambrinoudaki I, Goulis DG, et al.    EMAS position statement: Non-hormonal management of menopausal vasomotor symptoms. Maturitas. 2015 Apr 22. [Epub ahead of print]