Hot Flash Treatment News: Four Takeaways From NAMS 2020
The North American Menopause Society’s annual meeting highlights promising updates on nonhormonal and hormonal treatment for vasomotor symptoms.
The North American Menopause Society (NAMS) 2020 Conference starts September 30, and four different panels will emphasize the latest research on therapy for hot flashes and night sweats.
As many as 75 percent of North American women experience the disruption and discomfort of menopause-related hot flashes, or vasomotor symptoms (VMS). These usually persist for six months to two years. Some women, however, report experiencing hot flash symptoms for 10 years. For a small minority, they never go away.
Women Need a Variety of Hot Flash Treatment Options
“It is important to develop new therapies for hot flashes, because we know that one size does not fit all for any type of therapy.?We have used the same hormonal therapies for the last several decades and are developing an understanding that not all estrogens are alike, and different formulations and routes of administration are associated with different risk/benefit profiles. Developing new treatments will expand the choices available to women for management of what can be long-lasting and very bothersome symptoms for some women,” says Stephanie S. Faubion, MD, MBA, the medical director of NAMS and the Penny and Bill George director at the Center for Women's Health at the Mayo Clinic in Rochester, Minnesota, and Jacksonville, Florida.
Here are the top hot-flash treatment takeaways from this year’s conference.
1. A Nonhormonal Class of Drugs May Work for Hot Flashes
Nonhormonal options, such as SSRIs, SNRIs, gabapentin, oxybutynin, and clonidine?already exist;?Susan D. Reed, MD, MPH, of the department of obstetrics and gynecology at the University of Washington School of Medicine in Seattle, told Everyday Health that she will discuss the efficacy of other drugs that target the KNDy neuron complex (estrogen-sensitive neurons in the hypothalamus) at this year's meeting. During menopause, estrogen levels decrease dramatically, which causes the KNDy neurons to be hyperstimulated, spilling over and having an adverse effect on the adjacent thermoregulatory center.?
The result? Hot flashes and night sweats. Currently, the FDA hasn’t approved any therapies that target KNDy neurons for use for hot flashes. But there are drugs that target KNDy that are now under development for VMS treatment. So far, results have been very promising.
2. New Hormonal Therapies That Minimize Risks Are on the Horizon
Estrogen therapy has always been complicated — its benefits also come with risks. Experts have been searching, without much success, for selective estrogen receptor modulators (SERMs) that provide the benefit with minimal risk of breast cancer, stroke, blood clots, or heart attack.
Hugh S. Taylor, MD, at the department of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine in New Haven, Connecticut, will present data about a new approach that is developing two fetal estrogens with SERM-like properties, called estriol and estetrol, which are different from the commonly used estradiol. Estetrol has been shown to decrease VMS intensity and frequency while providing benefits to the cardiovascular system. Estriol can also lessen some of the bad effects of estradiol. Researchers are still exploring this possible breakthrough in hormonal therapy.
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3. Many Women Can Manage Hot Flashes Without Drugs
In 2015, NAMS provided a position statement on nonhormonal management of hot flashes. Janet S. Carpenter, PhD, RN, the Audrey Geisel Endowed Chair in Innovation and an associate dean of research at the Indiana School of Nursing in Indianapolis reviewed research done since then and will confirm the recommendations as still relevant:
- Treatments that were recommended in the position statement (cognitive behavioral therapy, clinical hypnosis) should continue to be recommended.
- Treatments that were recommended with caution in the position statement (mindfulness, weight loss, stellate ganglion block) should continue to be recommended with caution.
- Treatments that were not recommended in the position statement (exercise, acupuncture, yoga, paced respiration, relaxation, calibration of neural oscillations, chiropractic technique, cooling, avoiding triggers) should continue to not be recommended.
4.?Education Is Key to Managing Symptoms Without Hormones
For a panel on nonhormonal management of menopause, Catherine Hansen, MD, of the Empowered Women’s Circle in Houston, will report that while standard treatment is menopausal hormone therapy (HT or HRT), many women cannot tolerate HT or wish to avoid using it, yet aren’t fully informed about nonhormonal treatment options. This may lead them to use unproven, ineffective, or dangerous therapies. Dr. Hansen urges healthcare practitioners to educate themselves and their patients on appropriate nonhormonal care. Women should consult with their physicians before trying any new therapies, and it is best to follow plans that are appropriate for their individual and unique needs. What works for one woman may not work for another, and in fact, may be detrimental.
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Effective Hot Flash Treatments Exist; Most Nonmedical or Herbal Approaches Remain Unproven
Dr. Faubion concludes that the important takeaways from these panels are: “There are options out there for treatment of hot flashes. The only nonmedication therapies that have good evidence to support them for hot flash management are cognitive behavioral therapy and hypnosis. No over-the-counter herbs or supplements have been proved effective for hot flash treatment. At this time, hormone therapy is still the most effective option, and the benefits typically outweigh the risks for most symptomatic women under the age of 60 and within 10 years of menopause onset.”