Non-hormonal options are effective in treating menopause symptoms

The classic symptoms of menopause – hot flashes, sleeplessness, and vaginal dryness – have typically been treated with estrogen therapy. Studies published today report that non-hormonal options are effective, too.

These treatments may involve cognitive therapy to help a patient sleep, or using low doses of a class of drugs called selective serotonin uptake inhibitors (SSRIs) to treat hot flashes. SSRIs have traditionally been used to treat depression, but low doses effectively reduced hot flashes and night sweats, the researchers found.

"The [National Institutes of Health] asked us to give options to women for treatment of menopausal symptoms," said lead author Dr. Susan Reed, research director for the UW Medicine Women's Reproductive Health Research Center. The paper summarizes 10 years of data from five randomized trials performed by the research group known as MsFLASH.

The paper's senior author was Dr. Katherine Guthrie of the Public Health Sciences Division at Fred Hutchinson Cancer Research Center.

Hot flashes are the most common, but many bothersome symptoms arise in women going through menopause. Our goal has been to help women and their doctors identify which treatment options will work best for them and ultimately improve their quality of life."

Dr. Katherine Guthrie, paper's senior author

Reed remarked that many women tolerate hot flashes and night sweats, to some degree, "but what I see more women worried about is their ability to sleep or bothersome mood changes, that affects their ability to function in their work or home.

"It's really critical that women prioritize, with their primary care provider, what's bothering them most," Reed said.

Along this line, the group found that cognitive behavioral therapy delivered via phone conversations was very effective for improving sleep.

"This had not been studied before, with the party line being that estrogen was effective for sleep at midlife," Reed said. "But we found that a telephone-based intervention was as good as estrogen therapy, if not better. It would be exciting to see healthcare organizations looking at rolling out a simple, telephone-based therapy for menopausal sleep problems."

The study also evaluated common treatments, such as using the herbal supplement black cohosh or a diet rich in soy to treat hot flashes. The trials found these treatments ineffective. Yoga, exercise, and omega 3 vitamins also were evaluated for relief of hot flashes, but none was supported by the study data. Reed hastened to add, though, that yoga and exercise help overall quality of life and health.

The investigators also found that estrogen therapy in the form of a tablet did not provide symptom improvement for vaginal dryness that was any greater than observed with a placebo.

Reed said future research will examine the vaginal microbiome of menopausal women as well as the brain area beside the hypothalamus, which regulates body temperature and cold stimuli.

"We know there is a lot of crosstalk between the neurons in the reproductive center and this thermoregulatory center, and that they chat back an forth."

Non-hormonal medications are being developed to address thermoregulation, sleep, and weight gain and may provide relief for women with severe menopausal symptoms who are unable, or disinclined, to use hormonal therapies.