Management of Menopausal Symptoms
Source: New England Journal of Medicine
“Although it is reasonable to discuss behavioral changes (e.g., dressing in layers and lowering room temperature), such strategies are unlikely to be adequate in women with severe hot flushes. Women with moderate hot flushes, especially those with contraindications to or concerns about hormone therapy, may choose to try nonhormonal therapies, such as an SSRI or gabapentin, recognizing that there are limited data to support their use and that these medications are not approved by the FDA for this indication. Hormone therapy is the most effective treatment for severe hot flushes and is a reasonable choice in the absence of contraindications. If the patient has not had a hysterectomy, estrogen with an added progestin is recommended. She should be informed about potential side effects and risks but also told that the increase in the absolute risk of serious adverse events is low. The lowest dose of estrogen that adequately controls symptoms should be used. Given the natural history of vasomotor symptoms, it is reasonable to try discontinuing hormone therapy every 6 to 12 months. If symptoms recur, restarting and then gradually tapering the dose or the number of days per week that hormones are used may be helpful.57 Infrequently, vasomotor symptoms persist and require long-term treatment.”

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