Several studies have shown that gabapentin (Neurontin) at 600-2400 mg/day in divided doses is effective for treating hot flashes in menopausal women. Research presented at the annual meeting of the North American Menopause Society (NAMS) indicates that an investigational extended release (ER) formulation of gabapentin (Serada, Depomed) is effective for the treatment of hot flashes and sleep disturbance.
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.
Each year about 600,000 women in the United States undergo a hysterectomy. Somewhere between 55% and 80% of these women who also have their ovaries removed along with the uterus—a procedure known as oophorectomy. After the removal of the ovaries, menopause follows immediately and is associated with a constellation of symptoms including hot flashes and insomnia, as well as depression and anxiety.
The National Comorbidity Survey estimates that by the time women reach midlife, approximately 23% have experienced at least one episode of major depression and 30% have been diagnosed with an anxiety disorder. Depression and anxiety disorders are each associated with impaired functioning and lower quality of life (QOL). There is also some data to suggest that, even after a depressive episode resolves, those with a history of a affective illness have a lower quality of life than those without histories of depression, with impairment in social and interpersonal functioning.
Soy-based products have long been touted as a treatment for menopausal symptoms. However, many of the clinical studies measuring the effectiveness of dietary sources of soy isoflavones (e.g., soy beverages, soy powder) for the treatment of menopausal vasomotor symptoms (i.e., hot flushes, night sweats) have been negative. Less is known about the effects of soy on cognition. A large clinical trial suggests that soy may not have any positive effects on cognition in postmenopausal women.
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.
More than half of all women initiating treatment with hormone therapy will stop within the first year of treatment, most often because of side effects. Mood disturbance is a relatively common side effect that occurs with hormone therapy, and previous studies have suggested that progestins in the combined hormone preparations are responsible for these negative mood effects.
