Hormone replacement therapy (HRT) with estrogen (and often progestins) is the most effective treatment for vasomotor and vaginal symptoms of menopause. These include hot flashes, night sweats, vaginal dryness and painful sex.
HRT has gotten a bad reputation but is extremely helpful, life-changing, and is not as risky as we thought when used appropriately. This means, proper age, proper formulations, for a temporary time.
This does NOT include testosterone, pellet therapy, or bioidentical hormones that have not been studied and may be harmful.
However, in women who can’t or don’t want to use hormone therapy, there are other meds to try:
SSRIs & SSNRIs. These are antidepressants. The ones that work best are Paroxetine (Paxil) which is FDA approved for vasomotor symptoms. Desvenlafaxine (Pristiq) is also helpful.
Clonidine: This is a blood pressure medication. It’s not FDA approved for this indication but may still be used.
Gapabentin: This is a drug used for seizures and neuropathic pain. It doesn’t work as well as the SSRI/SSNRI class but is an option.
In regards to herbal products, none are FDA approved or regulated. There is also no good data showing that these preparations have efficacy for what we are trying to treat. Admittedly, it would be great to have good studies on them- I’m patiently waiting!
Phytoestrogens: found in soy products. All studies are either quite small or have not shown any benefit over placebo. Nor have they been shown to cause harm.
Black cohosh: This is in a lot of over-the-counter “female” herbal formulations. There is no good evidence to support its use at this time and may cause liver toxicity.
Acupuncture needs further study. Some report great relief in combination with Chinese medicine, though meta-review of 6 RCTrials showed no benefit over placebo.
Vitamin E has been shown to minimally reduce the amount of hot flushes per day.
Lifestyle changes may also help. Suggestions are to dress in layers, drink cold beverages, avoid caffeine and alcohol, exercise regularly, and maintain lower temp when inside.
It goes without saying: speak to your own doctor about what’s right for YOU!
(Info from ACOG Practice Bulletin 141)