A study to be published in an upcoming issue of Menopause suggests that stellate ganglion blockade (SGB) may be an effective option for women with vasomotor symptoms (VMS), including hot flashes and night sweats.  SGB is used primarily for pain management and involves the injection of local anesthetic into the stellate ganglion, part of the sympathetic nerve system located in the neck.

In a randomized placebo-controlled trial, 40 postmenopausal women (ages 30-70 years) who had moderate to severe vasomotor symptoms received either stellate ganglion blockade (SGB) or a sham injection.

While there was no observed effect on the overall reported frequency of VMS in the women treated with SGB, this group did experience a 50% reduction in the frequency of moderate to very severe VMS.  Although women in the sham control group showed a 34% reduction in reported VMS, objective monitoring showed no improvement in VMS in the sham control group compared to a 21% reduction in objective VMS in the SGB group.  No serious adverse events were reported.

One of the most important questions is how long this treatment lasts.  This will be investigated in future trials, but in this study the women were followed for a total of six months. After six months, women in the SGB group continued to report a reduction in VMS symptoms.  In contrast, women taking estrogen replacement therapy or SSRIs for vasomotor symptoms typically experience recurrent symptoms shortly after discontinuing treatment.

Researchers don’t know exactly how SGB works, but they hypothesize that this treatment blocks activity of the sympathetic nervous system and thus may affect blood flow and modulate norepinephrine levels in thermoregulatory areas of the brain.  Further study of this intervention is needed, but SGB may turn out to be an attractive option for women who do not want to use hormonal therapy or other medications, such as SSRI and SNRI antidepressants, to manage their menopausal symptoms.

Ruta Nonacs, MD PhD

Walega DR, Rubin LH, Banuvar S, Shulman LP, Maki PM.  Effects of stellate ganglion block on vasomotor symptoms: findings from a randomized controlled clinical trial in postmenopausal women.  Menopause. 2014 Feb 3. [Epub ahead of print]


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