Treatment of vasomotor symptoms: Is there an alternative to hormone replacement therapy?

Menopause is associated with vasomotor symptoms, which can affect the quality of life of some women. Although oestrogen replacement therapy is an effective treatment yet many women declines its use especially with the highly publicised findings of Women Health Initiative trials. Although oestrogen withdrawal is the main cause of hot flushes, neurotransmitter modulators are involved in its pathophysiology. Selective serotonin reuptake inhibitors as venlafaxine, flouxetine and paroxetine have been shown to reduce hot flushes by nearly 60% and are generally well tolerated. Trials on gabapentin, another group of neurotransmitter modulators, yielded similar results. Clonidine is a central α-adrenergic agonist, which is only modestly effective in reducing hot flushes. Their side effects may preclude their use but may be a suitable option for hypertensive patients with hot flushes. Non-prescription medications are widely popular as natural alternatives to hormone replacement therapy despite the lack of enough data regarding their safety. The current available evidence suggests that phytoestrogens are ineffective in treating hot flushes. Trials of black cohosh lack methodological quality and yielded conflicting results. Other herbal medicines are only included in isolated trials. Systemic progestogens can be effective in treating hot flushes but their long-term effect in breast cancer survivors is uncertain. There is little evidence to support progesterone cream for treatment of vasomotor symptoms. Many women might benefit of life style modifications and regular physical exercise.