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.
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.
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.
Peri- and post-menopausal women have various options for the management of hot flashes, including hormone replacement therapy, SSRIs, and gabapentin. It looks as if hypnosis may also be helpful. In a recent study, researchers randomly assigned postmenopausal women to hypnotherapy or "structured attention," which was used as a control intervention.
Multiple studies have shown that gabapentin (Neurontin) at 600-2400 mg/day in divided doses is effective for treating hot flashes in menopausal women. This study examines the efficacy of an extended release preparation.
For decades, estrogen has been used to treat menopausal symptoms, including night sweats and hot flashes. However, after studies reported that estrogen increases the risk of cardiovascular disease and breast cancer, many patients and clinicians have looked into alternative treatments for hot flashes, including selective serotonin reuptake inhibitors (SSRIs).
Selective serotonin and serotonin-norepinephrine inhibitors (SSRIs and SNRIs) have been shown to be effective for the treatment of hot flashes. However, these agents may carry certain side effects, including sexual side effects and sleep disturbance. These two side effects may be particularly concerning to peri- and postmenopausal women who, in addition to having vasomotor symptoms, are more likely to experience sexual dysfunction and sleep disruption than premenopausal women.
Various studies have shown that women with a higher body mass index (BMI) or a higher percent of body fat have more frequent or more severe menopausal symptoms. In a recent study, researchers evaluated the impact of a low-fat diet on vasomotor symptoms in a group of 17,473 postmenopausal women between the ages of 50 and 79.
