NAMS releases recommendations to treat menopause symptoms with nonhormone therapies
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Key takeaways:
- The Nonhormone Therapy Position Statement provides evidence-based recommendations for treating menopause symptoms.
- The statement also notes nonhormone therapy treatments that are not recommended to treat hot flashes.
The North American Menopause Society released its 2023 Nonhormone Therapy Position Statement recommending up-to-date scientific evidence for nonhormonal options for managing menopausal symptoms.
The 2023 position statement is an update to the Nonhormonal Management of Menopause-Associated Vasomotor Symptoms 2015 Position Statement and has been published in Menopause.
“Many women cannot or prefer not to take hormone therapy for hot flashes, but they are often unsure of what nonhormone options work and what doesn’t,” Chrisandra L. Shufelt, MD, MS, FACP, NCMP, chair of the division of general internal medicine, senior consultant at the Mayo Clinic Women’s Health, associate director of the Women’s Health Research Center at the Mayo Clinic and lead of the advisory board panel for the 2023 Nonhormone Therapy Position Statement, said in a related press release. “Now, with help from this position statement, health care professionals can confidently guide women to effective nonhormone therapies and steer them away from inappropriate or ineffective therapies.”
A NAMS advisory panel of clinician-researchers with expertise in nonhormone medical therapy, herbal therapy, behavioral therapy and lifestyle approaches for vasomotor symptoms reviewed literature published since the 2015 position statement. The panel divided topics into sections: lifestyle, mind-body techniques, prescription therapies, dietary supplements and acupuncture, other treatments and technologies. Using the most current and up-to-date literature, the panel developed evidence-based recommendations for women who are not good candidates for hormone therapy and should be treated with nonhormone therapy alternatives.
The evidence-based position statement presents several recommendations for nonhormone therapy treatment for women who experience hot flashes:
- cognitive behavioral therapy;
- clinical hypnosis;
- weight loss;
- stellate ganglion blockade;
- selective serotonin reuptake inhibitors/serotonin-norepinephrine uptake inhibitors;
- gabapentin;
- oxybutynin; and
- fezolinetant (Veozah, Astellas).
The position statement also lists therapies not recommended for managing menopausal symptoms:
- paced respiration;
- supplements/herbal remedies;
- cooling techniques;
- avoiding triggers;
- exercise and yoga;
- mindfulness-based intervention;
- relaxation;
- suvorexant;
- soy products;
- cannabinoids;
- acupuncture;
- calibration of neural oscillations;
- chiropractic interventions;
- clonidine;
- dietary modification; and
- pregabalin.
According to the NAMS advisory panel, it is important for clinicians to be knowledgeable of available nonhormone therapy options that are supported by evidence to offer to women who are unable or do not wish to use hormone therapy.
“The good news for women is that there are many options available for the treatment of bothersome hot flashes, including several nonhormone therapies,” Stephanie S. Faubion, MD, MBA, medical director of NAMS, director of the Mayo Clinic Center for Women’s Health and a Healio | Women’s Health & OB/GYN Peer Perspective Board Member, said. “We also have a better understanding of what is not effective so that women and health care professionals can target therapies that have been proven to work and avoid the wasted time, energy and expense associated with ineffective or unproven remedies.”
Reference:
- The North American Menopause Society releases its 2023 Nonhormone Therapy Position Statement. www.menopause.org/docs/default-source/press-release/nonhormone-therapy-position-statement-release.pdf. Published June 1, 2023. Accessed June 7, 2023.
Perspective
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The North American Menopause Society has just issued its 2023 nonhormone therapy position statement. There are many therapies available for vasomotor symptomatology that do have efficacy. Unfortunately, many of these therapies also have some significant side effects, which need to be discussed when prescribing them for patients. Popular prescription remedies such as SSRIs and SNRIs can lead to weight gain and decreased libido, and gabapentin can lead to bloating and fatigue, all of which can be felt by many women to be menopausal side effects. Oxybutynin can lead to dry mouth and constipation and has been implicated in long-term risk for dementia. All except one of the SSRIs, low-dose paroxetine, are off-label medications for menopausal intervention. Fortunately, we now have a drug designed for vasomotor symptoms with minimal side effects, namely fezolinetant.
Fortunately, this statement should be accessible for women to be able to check if products that are being touted to them by nonprofessionals, primarily non-medical influencers, have any reasonable chance of helping their symptomatology. I would also suggest that if women are suffering from vasomotor symptoms and are looking for reliable help and are not receiving it from their current providers, that they use the NAMS website, menopause.org, in the “find a provider” section where they can plug in their zip code and find a menopause practitioner close to them who can help guide them to relief using reliable interventions, both hormonal and nonhormonal.
Perspective
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NAMS has provided practitioners with an up-to-date review of available nonhormone treatments for hot flashes. This is a welcome addition to clinical practice, as many patients cannot or do not wish to take hormone therapy for their menopausal hot flashes. What is new in this statement is that behavioral interventions are covered in more detail, and there is a little more evidence to back up the efficacy of treatments such as cognitive behavioral therapy. The statement also puts to rest some treatments that have not withstood the test of time, such as paced respiration and a variety of herbal supplements and “nutriceuticals.” Although some treatments such as cooling devices and clonidine are not recommended, I have many patients who report relief from these modalities, and I would view “not recommended” in this context as being not recommended as a first-line agent. Some individuals who do not fare well with the more evidence-based therapies may benefit from these interventions. Finally, the statement includes the new, first-in-class neurokinin-3 receptor antagonist, fezolinetant, which is the second nonhormone treatment to be FDA approved for hot flashes. Since it has just recently become available for widespread clinical use, it’s practical efficacy under ‘real life’ conditions cannot yet be appreciated, but this class of compounds provide exciting new potential treatments for this most bothersome of menopausal symptoms!
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