Strategies for managing hot flashes
Hormone therapy—at the lowest possible dose for the shortest period of time—remains the best option for menopausal women with moderate to severe vasomotor symptoms.
What the future holds
The selective estrogen receptor agonist MF-101, which can induce tissue-specific estrogen-like effects, has been shown to be effective in reducing menopausal hot flashes compared with placebo in a phase II trial.56 A larger phase III trial is in progress.
Lower and ultra-lower doses of systemic estrogen are now available and approved by the FDA, and were found effective in relieving vasomotor symptoms.57-59 The drawback of these preparations is that they may take longer than standard-dose estrogen to achieve maximum relief of symptoms (8-12 weeks vs 4 weeks, respectively). The lower doses have been associated with fewer adverse effects (such as vaginal bleeding and breast tenderness) compared with the standard doses.58,59 Their long-term effects on the cardiovascular system, bone, and breast are still being tested and need to be established.
Newer selective estrogen receptor modulators, especially in combination with estrogen, are another approach to menopausal symptoms currently in testing.60
CORRESPONDENCE
Ghufran A. Jassim, MD, ABMS, MSc, Department of Family and Community Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, PO Box 15503, Adliya, Bahrain; gjassim@rcsi-mub.com
