Many women transitioning into the menopause request medical advice on ways to improve their quality of life and to relieve the symptoms associated with the menopausal transition. With concerns regarding the long-term use of estrogen replacement therapy, there has been interest in the use of non-hormonal strategies to manage these symptoms.
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.
Following the publication of the Women's Health Initiative report in 2002, there was a dramatic drop in the use of hormone-replacement therapy (HRT) due to concerns about increased risk of heart disease, breast cancer, and stroke. Since that time, various non-hormonal alternatives have been utilized for the treatment of menopausal symptoms, including gabapentin and various serotonin reuptake inhibitors.
Previous studies have shown that the abrupt hormonal changes that occur after a surgical menopause (i.e., removal of the ovaries) negatively affect cognition in women. According to a recent study, "Women who were younger at the time of surgical menopause have a more rapid rate (steeper slope) of cognitive decline than women who were older at the time of surgery or than women undergoing natural menopause." Earlier age at menopause was also associated with increased Alzheimer’s disease neuropathology, in particular neuritic plaques.
The US Food and Drug Administration (FDA) has approved a novel estrogen-based drug for women for the treatment of moderate-to-severe vasomotor symptoms and osteoporosis associated with menopause. Duavee (Wyeth Pharmaceuticals) is a once-a-day tablet containing a combination of conjugated estrogens and bazedoxifene, an estrogen agonist/antagonist.
Several recent studies have examined the impact of various types of physical activity on menopausal symptoms, including hot flashes, night sweats, and sleep disturbance.
Approximately seventy percent of all women experience hot flashes and/or night sweats 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, but today many women are pursuing non-hormonal treatments, including over-the-counter complementary and alternative medicines (CAMs) for the treatment of these symptoms.
In a recent study comparing hot flashes in 934 cancer survivors (90% of whom had breast cancer) and 155 age-matched control subjects who never had cancer, researches observed that cancer survivors reported more frequent, severe, and troubling hot flashes.
In a recent randomized, single-blind, controlled, clinical trial, 187 postmenopausal women reporting at least 7 hot flashes per day received five weekly sessions of either clinical hypnosis or structured-attention control. Hot flash score were assessed by daily diaries on weeks 2 to 6 and at week 12.
The FDA recently approved a 7.5-mg formulation of the selective serotonin reuptake inhibitor (SSRI) paroxetine mesylate for the treatment of hot flashes. It will be marketed under the name of Brisdelle.
