For the first time in a dozen years, a leader OB-GYN group has updated its advice on managing hot flashes, night sweats, sleep changes and other disruptive symptoms that often accompany menopause.
Doctors emphasized the importance of hormonal therapiesthat many women consider again after removing the federal safety warnings. On Friday, federal officials said the Food and Drug Administration had taken steps to ensure adequate supplies.
Doctors have also described various non-hormonal options in the new advisory released this month by the American College of Obstetricians & Gynecologists, or ACOG.
“We would like our patients to go to their obstetrician-gynecologist about questions about menopause and really advocate to get the treatment they need,” said Dr. Camille Clare, president of the group.
Menopause occurs when a woman goes 12 consecutive months without a period. In the United States, this usually happens around age 50. The period before this is called perimenopause, during which the body’s production of estrogen and progesterone decreases sharply.
Problems arise frequently. More than half of postmenopausal women report having “vasomotor” problems such as hot flashes and night sweats, ACOG said. Up to two thirds of them report sleep problems linked to menopause. And more than a third of perimenopausal and postmenopausal women worldwide report depressive symptoms.
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In the past, doctors said, many women suffered quietly.
There is a growing consensus that “these symptoms need to be treated,” said Dr. JoAnn Manson, professor of medicine at Harvard Medical School. “This should allow women to discuss their symptoms with their healthcare professional. »
Hormone therapy is considered a good option for many people
Manson said ACOG’s new guidelines are similar to those issued by other medical organizations.
“Moderate to severe or bothersome symptoms of menopause should be treated with hormone therapy as first line therapy,” she said. Although it may not be suitable for all women, she added, it is a good option for many.
But some are wary.
In 2002, a landmark study of women taking a combination of estrogen and progestin pills was stopped early due to links to breast cancer, blood clots and other serious problems. Concerns persisted even though subsequent studies showed that the benefits of current hormone therapies outweigh the risks for many women. For more than 22 years, all menopause hormone treatments carried a government warning that Manson said discouraged patients and doctors from using them.
But last year, the FDA announced it would remove the boxed warning from more than 20 pills, patches and creams containing the hormones estrogen and progestin. On Friday, the FDA approved updated labeling for three additional estrogen patches.
Removing the boxed warning has helped revive interest and demand for the treatments.
Since the FDA labeling change, some women have reported difficulty obtaining estrogen patches in certain doses and formulations.
FDA officials said Friday that despite these reports, they were not aware of an “imminent risk of nationwide shortage.” Officials also noted that drugmakers have doubled their product output over the past year by adding additional manufacturing teams and production capacity.
Dr. Stephanie Faubion, medical director of the Menopause Society, said she was pleased to see the ACOG guidelines emphasize the importance of these treatments. “There is no doubt that hormone therapy is the first-line and most effective treatment for hot flashes,” she said.
ACOG reviews the latest evidence on hormone therapy and includes detailed information on the different types. Whole-body therapies, which come in the form of pills, patches, sprays, gels and vaginal rings, deliver doses of hormones into the bloodstream at levels high enough to have significant effects on symptoms such as hot flashes. Low-dose vaginal estrogen therapy is applied directly with very little circulation in the bloodstream. It is often prescribed to women whose main problem is vaginal dryness.
ACOG recommends that decisions about hormone therapy be made jointly by physicians and patients and consider the benefits and risks given the patient’s age and medical history. If appropriate, the group advises starting it before age 60 or within 10 years of menopause.
Hormones are not the only treatments
Some patients choose not to take whole-body hormonal medications or are advised by their doctor to avoid them based on their medical history or health condition.
For them, the doctors indicated different medications. One of them is fezolinetant, which works in the area of the brain that controls body temperature and blocks a source of hot flashes and night sweats. Another is elinzanetant, which works the same way.
Doctors also said that certain antidepressants can help manage symptoms such as hot flashes and depression in patients with either or both of these problems.
There is also evidence supporting some nondrug treatments for hot flashes, night sweats and sleep or mood problems, ACOG said. These include cognitive behavioral therapy, mindfulness, exercise, clinical hypnosis and acupuncture. Such approaches can be used alone or in combination with medications.
Clare said women may see misinformation and misinformation about menopause treatments online, and urged patients to speak to their doctor with any questions. ACOG offers tips for sorting out fact from fiction as well as general information about menopause.
“Women have options. They have a lot of options, hormonal and non-hormonal,” Faubion said. “They shouldn’t be told that nothing can be done about their symptoms. Because, again, we have evidence of many different things that can help them.”
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AP Health Editor Matthew Perrone contributed to this report.
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