Abstract
Abbreviations and Acronyms:
CBT (cognitive behavioral therapy), CYP2D6 (cytochrome P450 2D6), DHEA (dehydroepiandrosterone), FDA (Food and Drug Administration), GSM (genitourinary syndrome of menopause), MPA (medroxyprogesterone acetate), SERM (selective estrogen receptor modulator), SGB (stellate ganglion blockade), SNRI (serotonin norepinephrine reuptake inhibitor), SSRI (selective serotonin reuptake inhibitor), VMS (vasomotor symptoms)- 1.Read the activity.
- 2.Complete the online CME Test and Evaluation. Participants must achieve a score of 80% on the CME Test. One retake is allowed.
Vasomotor Symptoms
Nonprescription Treatments for VMS
Lifestyle Measures
Mind-Body Approaches
Over-the-Counter Herbs and Supplements
Nonhormonal Prescription Treatments for VMS
Clonidine
Antidepressant Agents
Gabapentinoids
Which Do Women Prefer, Venlafaxine or Gabapentin?
Oxybutynin
Laguardia KD, inventor. Treatment of hot flashes using muscarinic receptor antagonists such as oxybutynin [patent report]. 2007. http://www.google.com/patents/WO2007143486A2?cl=en. Accessed April 29, 2016.
Stellate Ganglion Blockade
Hormone Treatments for VMS
What Is Known About Treating VMS in Men?
- Irani J.
- Salomon L.
- Oba R.
- Bouchard P.
- Mottet N.
Treatment type and specific therapy | Examples and recommended target dose | Notes | References |
---|---|---|---|
Lifestyle | |||
Avoidance of triggers and reduction of body heat | Keeping the room cool; using fans; dressing in layers; wearing open-weave fabrics; avoiding spicy foods, alcohol, and other hot flash triggers | Low cost and nontoxic | 9 , 10 |
Mind-body | |||
Cognitive behavioral therapy | Group or self-guided | Reduces hot flash severity, not frequency; requires expertise not widely available | 20 , 21 |
Hypnosis | Weekly for 3-5 wk | Requires expertise not widely available | 22 , 23 , 24 , 25 |
Nonhormone | |||
Antidepressants (SSRIs and SNRIs) | Venlafaxine 75 mg/d | Can be considered as first-line therapy; escalate and taper dose slowly to avoid adverse effects | 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 86 ,
Efficacy of venlafaxine, medroxyprogesterone acetate, and cyproterone acetate for the treatment of vasomotor hot flushes in men taking gonadotropin-releasing hormone analogues for prostate cancer: a double-blind, randomised trial. Lancet Oncol. 2010; 11: 147-154 97 , 98 , 99 , 100 , 101 |
Desvenlafaxine 150 mg/d | More expensive and less well-studied than venlafaxine | ||
Paroxetine 7.5 mg/d | Only FDA-approved therapy for treatment of hot flashes; best to avoid in patients taking tamoxifen due to inhibition of CYP2D6 | ||
Citalopram 20 mg/d | Preferred first-line therapy for many patients because of low cost, low toxicity, and minimal CYP2D6 inhibition | ||
Escitalopram 20 mg/d | Reasonable first-line therapy, but more expensive than citalopram | ||
Clonidine | 0.1 mg/d | Rarely used because of toxicities and availability of alternative options | 38 , 39 , 96 |
Gabapentinoids | Gabapentin 900 mg/d | May be particularly helpful for patients with prominent night sweats | 56 , 57 , 58 , 59 , 60 , 61 , 95 |
Pregabalin 150 mg/d | More expensive and less well-studied than gabapentin | ||
Oxybutynin | 5 mg twice daily | Recommendation based on published pilot data; placebo-controlled trials needed | 62 , 63 Laguardia KD, inventor. Treatment of hot flashes using muscarinic receptor antagonists such as oxybutynin [patent report]. 2007. http://www.google.com/patents/WO2007143486A2?cl=en. Accessed April 29, 2016. |
Stellate ganglion blockade | Optimal frequency and duration are unclear | Carries a small risk of damage to vessels and nerves in the neck | 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 |
Hormone | |||
Estrogens | — | Usually not used in survivors of hormonally responsive cancers | 6 , 7 , 88 , 89 |
Progesterone analogs | Megestrol acetate, medroxyprogesterone acetate | Lack of well-defined risk-benefit data in survivors of hormonally responsive cancers | 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 86 ,
Efficacy of venlafaxine, medroxyprogesterone acetate, and cyproterone acetate for the treatment of vasomotor hot flushes in men taking gonadotropin-releasing hormone analogues for prostate cancer: a double-blind, randomised trial. Lancet Oncol. 2010; 11: 147-154 87 |
Genitourinary Syndrome of Menopause
Treatment type and specific therapy | Examples and dosages | Notes | References |
---|---|---|---|
Nonprescription | |||
Lubricants | — | Used as needed for sexual activity | — |
Moisturizers | — | Used several times per week to maintain vaginal moisture | 102 |
Hyaluronic acid gel | — | Used intravaginally every 3 d | 106 , 107 |
Nonhormone | |||
Topical lidocaine | 4% aqueous lidocaine | Applied to the vulvar vestibule as needed several minutes before penetration | 125 |
Hormone | |||
Low-dose vaginal estrogen | Available in vaginal cream, 10-μg tablet, or ring | Low-level systemic absorption of unclear clinical significance is possible with existing local vaginal estrogen products; not recommended in patients with a history of breast cancer taking aromatase inhibitors | 102 , 108 , 109 , 110 |
Intravaginal DHEA | 3.25 or 6.5 mg of 0.5% intravaginally daily | Long-term safety data in breast cancer survivors are lacking, but no evidence of increased estradiol levels in patients taking aromatase inhibitors | 112 , 113 , 114 |
Ospemifene (oral SERM) | 60 mg/d by mouth | Not FDA approved for use in women with or at high risk for breast cancer | 115 , 116 , 117 , 118 |
Sexual Dysfunction
Conclusion
Supplemental Online Material
References
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