(Reuters Health) – Managing menopausal symptoms like hot flashes may be possible without taking hormones, but the evidence supporting most alternatives is weak, European researchers say.
A multinational team analyzed past studies on treatments ranging from exercise to antidepressants and behavioral therapy, in a review conducted for the European Menopause and Andropause Society (EMAS).
Lead study author Gesthimani Mintziori, of the Aristotle University of Thessaloniki, Greece, told Reuters Health the group drafted the position paper on hormone alternatives because it could be confusing for women “to figure out what works best or what would work better for them.”
The review is meant to help doctors help their patients navigate the options. “In any case the choice of therapy should be the result of a joint decision-making procedure, together with their physician,” he said in an email.
Because many women do not want to take hormones, or cannot take them for medical reasons, the authors reviewed studies that assessed a wide range of alternatives – including lifestyle modifications, diet and food supplements, prescription medications, and behavioral and alternative/complementary therapies.
The results were decidedly mixed, they reported online April 22 in Maturitas.
However, “for women who cannot or do not wish to take estrogens, non-hormonal management is now a realistic option,” they wrote.
For exercise, there was insufficient or conflicting evidence that it relieved hot flashes, but the researchers say it is worth trying because it could help improve overall quality of life and offset the increase in heart disease risk women face after menopause.
Evidence for supplements or a diet rich in phytoestrogens was also weak.
For selective serotonin-reuptake inhibitors (SSRIs) and serotonin norepinephrine-reuptake inhibitors (SNRIs), there was evidence that they are effective in decreasing both the frequency and severity of hot flashes. Only paroxetine (Brisdelle, Noven Therapeutics) has been approved in the U.S. to treat hot flashes.
Gababentin has also been studied as an alternative to hormone therapy, and some research has found it to be effective as well.
Finally, for behavioral interventions such as cognitive therapy, and alternative medical therapy such as acupuncture, the available evidence is still limited.
Dr. Wulf Utian, medical director for The North American Menopause Society, said he doesn’t feel this is the definitive guideline for what works and what doesn’t.
“There were a number of problems with the methodology of this paper,” said Utian, who was not involved in the review. “And none of the papers they reviewed gave a level of evidence. There also isn’t any algorithm for managing symptoms.”
While the position paper pointed out that many of the non-hormonal interventions are not effective, he noted that “if there is one thing we know about hot flashes, there is a high placebo effect when it comes to treatment.” But, he said, “what difference does it make as long as it makes a woman feel better.”
Utian added that while there isn’t a lot of evidence for many of the nonprescription interventions, they also tend not to have any side effects, like some of the drugs. “Women can try them out, and if it makes them feel better, then fine. If not, then they need to have a full discussion with their provider about hormones, which is really the most effective treatment.”
— Roxanne Nelson