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Finding the "Just Right" Non-hormonal Prescription Therapy for Your Menopause Symptoms

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Finding the "Just Right" Non-hormonal Prescription Therapy for Your Menopause Symptoms

Feb 21, 2024

Managing menopause symptoms is not easy, and it can be difficult to find the most effective treatment option. Women's health specialist Kirtly Parker Jones, MD, and menopause expert, Camille Moreno, DO, NCMP, discuss traditional hormonal treatments and the suitability of various options based on health history. The two also talk about a novel, hormone-free prescription treatment for hot flashes that targets the brain's temperature control.

Episode Transcript

Dr. Jones: We're going to talk about hot flashes. I'm Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah, and as someone trained in menopausal medicine, I know there are many options for hot flashes, and now there are some new ones.

But let's just think about Goldilocks who said, "I'm too hot. No, no, I'm too cold. Wait, I'm just right." This is how Goldilocks experiences menopause. You may not have grown up with the Goldilocks fairytale of a little girl trying to find just the right fit. And even if you did grow up with the most famous fairytale in the English language, you may not identify with Goldilocks. But trying to find that "just right" to help you feel the best in your menopausal transition is a journey for sure.

So today, we're going to take a journey and a talk with Dr. Camille Moreno, who's going to help us think about the medical treatment of hot flashes.

Dr. Moreno is the Medical Director of the Midlife Women's Health and Menopause Medicine Program. She is board-certified in family medicine and did her specialty training in women's health with a focus on midlife women's health at the Cleveland Clinic. Her clinical experiences cover a broad range of menopause and midlife women's health issues, but today we're taking care of Goldilocks who's having hot flashes.

Welcome, Dr. Moreno.

Dr. Moreno: Thank you, Kirtly. Very excited to be here.

Hot Flashes Symptoms and Frequency

Dr. Jones: Yeah, thank you. So can you briefly describe a hot flash for me, and then tell me who gets them?

Dr. Moreno: Yes. So a hot flash is a sudden sense of warmth and feeling heat typically in the upper body. So it can be along your chest area, neck, even face, and you can even have the actual flushing of your skin or the reddening of the skin. And this is very common among perimenopausal and menopausal women, about 75% to 80% of the time. And so this is important to talk about with your healthcare provider.

Dr. Jones: Yeah, my mom was always a great sweater. She managed to make a lot of sweat, and as a dental hygienist, she'd be leaning over her patients doing her work and have a hot flash and she would drip on them. It was so embarrassing for her, and she really needed someone to help her with this.

Hormonal Therapy is the Most Effective Treatment for Hot Flashes

So what's the most effective treatment, and who's a good candidate for it?

Dr. Moreno: So the most effective treatment is hormonal therapy, or what we call menopausal hormone therapy, or MHT for short. And this is a great option for individuals who've never had a history of stroke, heart attack, blood clot in the leg, blood clot in the lung, or have a history of liver disease or liver issues, and estrogen-sensitive or estrogen receptor-positive cancers such as breast cancer. This is about 87% of the time effective in women who are starting menopausal hormone therapy within 10 years of their menopause onset or their last menstrual period.

Dr. Jones: So it works pretty well. I mean, I used to tell my patients that I wasn't going to be able to help them get rid of every single hot flash, but it would make them feel better. It'd be more tolerable.

Hot Flashes Treatment Options Beyond Hormonal Therapy

Now, women who try one estrogen therapy don't always feel right, but they shouldn't give it up because there are lots of options. Can you talk about that?

Dr. Moreno: Yeah, absolutely. So there are many formulations for estrogen. For women who've had a hysterectomy, so removal of their uterus surgically, they can safely take estrogen therapy alone, which can be provided either in oral form or what we call transdermal. Transdermal can be in the patch, gel, or spray form, and these overall are considered safer formulations since they bypass the liver and have a lower risk for blood clots. Oral does go through the liver, and so it is not for everyone. Not a great option for women who have a history or have a high susceptibility to getting blood clots.

But there are also other non-hormonal options for women who are not good candidates for estrogen. And so typically, we would provide or talk about options that are used for depression, anxiety, so what we call SSRIs, SNRIs, or antidepressants, which are used off-label to help with hot flashes and night sweats for women, again, who are not good candidates for hormone therapy.

Dr. Jones: Right. So I think that the clinician you choose, if you're seeking care, needs to know about all the different things that are effective, maybe not as effective as estrogen, but can make you feel better.

And now there are some really new things out there. Can you help us think about these new things? Because it's a complicated molecule that's out there to help women with hot flashes.

Advancements in Menopausal Care

Dr. Moreno: Yeah. So there are newer options now, and one actually is a hormone-free option that was just approved by the FDA in May of 2023, so just last year. This is a special type of prescription therapy that works specifically at the hypothalamus, the area or part of the brain that controls temperature or temperature regulation. So it truly blocks the source of hot flashes and night sweats, anywhere from 50% or higher. This is also a great option for women who are not good candidates for hormone therapy.

Dr. Jones: Right. But you still are able to control your temperature in terms of going out. You can be cold or hot, but it's just the hot flash part that it helps you with, right?

Dr. Moreno: That's right. So hot flashes during the day and night sweats, which are hot flashes that women experience at night, may cause sleep interruptions.

Dr. Jones: Right. And you've been prescribing this now probably for almost a year. Tell me what your patients have been telling you.

Dr. Moreno: It's a great option for hot flashes and night sweats solely for those symptoms. And again, for women who are bothered just by those symptoms and maybe not by vaginal dryness, low sex drive, brain fog, or cognitive changes. So it works well for those who have bothersome hot flashes/night sweats that are causing sleep disturbances.

Dr. Jones: Right. So there's a whole number of other symptoms that are associated with menopause, and we'll get to those on another podcast. But for day and night flashes, it's nice to know there's something different.

Cultural Considerations in Menopausal Care

You need to see someone who's pretty good at thinking about this. And I know women from different cultures and different backgrounds may experience menopause differently, and many clinicians may not be aware of those differences. Can you talk about your team and your team's approaches to women who bring a different cultural or personal view of menopause?

Dr. Moreno: Yeah, that's a very good point to bring up since women of color in particular enter perimenopause earlier than the Caucasian and Asian American ethnicities. Women who are of African American descent and Hispanic women tend to be bothered by more severe vasomotor symptoms, which are hot flashes and night sweats as we had alluded to earlier, but they truly do suffer from a longer duration of these symptoms, unfortunately. And so it is good to talk to your healthcare provider about these symptoms as early as perimenopause.

Menopausal Care Resources and Support at University of Utah

A great resource for this would be University of Utah which has a Midlife Women's Health and Menopause Medicine Program. An easy way to access information about the different healthcare providers who specialize in menopause is our webpage.

There's also the Menopause Society web page as well that provides resources for women in the community wanting to see a menopause-certified provider, who are also coming from different cultural backgrounds and may be able to relate a little bit better as far as culturally congruent traditional approaches to helping you manage your hot flashes and night sweats.

Dr. Jones: For people listening, everyone experiences menopause in their own way, and you should know that there are many options to help you feel better. Our team at the Midlife Women's Health and Menopause Clinic here at the University of Utah can help you find a plan that is just right for you. Thanks for joining us, Camille.