Since I am a Psych NP, I mainly use SSRI's and SNRI's which are somewhat effective for some. The numbers do seem similar to what I see.

Numerous studies have shown the strong correlation between VMS and endothelial dysfunction and increase rate of heart disease. I strongly disagree with treating symptoms.

I have dealt with this issue in my patients. Some have been on SSRI’s and or HRT, but still struggle. I went to the Mayo Endocrine conference and one of the doctors at the conference suggested gabapentin for those who still had symptoms or could not use HRT. It has worked well with the patients I have prescribed this to.

Metagenics has Estrovera. It has helped many pt's. I have written also for ssri/snri's, crms ets. Each pt is individual and it depends what is best for them.

I agree with the numbers and I also believe iot does affect patients quality of life. I use paroxetine, fluoxetine, effexor, and wellbutrin all in low doses to help treat vasomotor symptoms. some more effective than others.

I too, argree that these numbers are accurate, and may even be higher since a lot of patients are embarrassed by them and don't want to discuss them. I use paroxetine, fluoxetine, effexor, and wellbutrin all in low doses to help treat vasomotor symptoms.

VMS symptoms are common but rarely enough to to interfere with daily quality of life. For those patients with symptoms enough to interfere with QOL, they accept the risks for HRT. I found herbal therapy to be a common therapy used to reduce the need for HRT

I think the statics are right but most people have symptoms that are manageable. There is somewhat of a psychological component to it (women experience symptoms talking about hot flashes). Mindfulness and relaxation techniques can help. Many women with significant symptoms benefit from SSRIs.

Marcia Harris from the wellness restoration center. In my more than 25 year experience with now thousands of patients the incidence is higher than that. Most of the time, however, the symptoms are mild and do not interfere with quality of life. If questioned/elicited most women will admit to having symptoms. These are questions most practitioners dont think of asking and most women dont volunteer. It is very important that we not only ask but treat. Yes, there is distrust because of previous information which we now know to be flawed. However, explained properly as to its importance, most will accept treatment. It is a fact that every cell has hormone receptors and is affected by the decline. Maintaining the hormone levels are therefore protective and the reason women live longer than symptomatic treatment does nothing for the root cause of the problem

Topical compounded HRT can provide symptom relief without systemic risks. I also use SSRIs such as Paxil to provide relief. I see similar numbers in my practice as noted in the question.

I will also say that upwards of 80% of the 40-65years age range do indicate vasomotor symptoms but the majority are mild with little effect on their quality of life. Those with contraindications to hormone replacement therapy do benefit from the use of SSRIs like Paxil .

Vasomotor symptoms in the menopausal setting are the most bothersome symptoms and HRT is still the most effective treatment avaibale to deal it when indicated and acceptance is much higher than the one reported here but when these symptoms are combined with mood symptoms then SSRI do a much better job IMO HRT is quite safe treatment to be started on and has the same experience all along and ever effort should be made to start it the stigms of the HRT stems from Womens Health Initiative Study which is taken with a pinch of salt as the cohort that was study however the good news is that a new med is on the way to deal with the VMS and has shown promising results in trials and will be avaibale soon ""NKB inhibitors may be the best option for women who have had breast cancer or who fear breast cancer or have other contraindications to hormone therapy, such as increased risk of blood clots, heart disease, or stroke, or who have symptoms persisting for longer durations or starting up again after age 60""

Those numbers are higher than what I see in my primary care practice. I provide a lot of information to per-menopausal women and educate them about treatment options, including risks/benefits. Hot flashes are the most bothersome symptom and my patients have responded well to SSRI or gabapentin treatment.

MARCIA HARRIS from NY WELLNESS RESTORATION CENTER September 2022
What i have found works best is pellet therapy which I have used with 95% of my patients for more than 25 years. I use transdermal estradiol and oral progesterone for patients not comfortable doing pellets. Done and dosed properly they are 95% effective.

I assure the patients that the interpretation of the original studies appeared to have been flawed. There is no uncreased breats cancer risk and the thrombosis risk is with oral estrogen. The additional benefits of pellet therapy ie prevention and even reversal of osteopenia/osteoporosis (great studies!), make it worth it.

HRT is rarely not an option considering quality of life issues, and age range also has to be factored in We really no longer have to suffer and be nonfunctional! ( see Dr Rebecca Glazer's work)

I find that many SSRIs and SNRIs work , I have used low dose clonidine with Vasomotor symptoms causing insomnia,also OTC supplements estroven and black cohosh , have sometimes used estrogen vaginal cream, but do not prefer HRT

Testosterone is a wonderful therapy for the prevention of osteopenia and sarcopenia and all the ravages of menopause - read Dr Rebecca Glazer ‘s work

I prescribe a lot of hormones. I opt for transdermal estradiol 95% of the time with oral progesterone. I also do pellet therapy and vaginal estradiol. I have testosterone topical cream compounded and I have had great success reducing symptoms. SSRI's may work very well in women who have underlying depression but in a few instances, you may have a patient who becomes more depressed with SI after taking an SSRI.

I agree with a previous poster that actual occurrence is much higher. I prescribe topical bio identical hormone replacement therapy as well as SSRIs frequently for the symptoms described.

As an OB/GYN, I agree with the statistics. I also agree that presently transdermal estrogen is the best treatment. However, many women still balk at the idea of using an estrogen product, despite my counseling. I highly await the FDA approval of neurokinin B blockers, such as fezolinetant. If they work as well and safely as promised, I believe that this new class of drug treatment targeting the KNDy neuron in the hypothalamus will be a gamechanger!

As menopause specialist, we often see patients who fear they cannot take HRT. With Marianne Cannonico's study in Circulation 2008 showed the risk of thrombosis to be with oral estrogens and progestins, but no increased risk with transdermal estrogen. For breast cancer, the E3N EPIC cohort, while observational data, the study showed in women the cohort who used trandermal estradiol and micronized progesterone had no increased risk of breast cancer compared to women who took no hormones. Taking all of that into consideration, if HRT is still not an option, we recommend a rhubarb supplement called Estrovera, Evening Primrose oil or Black Cohash.

I agree & pts feel better with treatment to decrease symptoms .

I agree with these numbers. I prescribe SSRI, SNRI and topical therapies to help alleviate symptoms . Patients seem to have an automatic "no way" response to treating VMS with hormonal therapy. This subject requires extra education and patience

I agree with these findings, I have been using SSRI, SNRI, helped patients symptoms, , also instructed to avoid alcohol, caffeine, spicy foods

I have seen similar stats. I try to accommodate patients desire. Some prefer complementary & alternative medicine (CAM) approach like hypnosis, cognitive behavioral therapy, yoga, meditation, and aromatherapy. Herbal treatment include black cohosh, MACA root, Evening Primrose Oil. For prescriptions, I will use SSRIs like Paroxetine and SNRIs like Effexor, Cymbalta &Wellbutrin. I have also used Clonidine and Gabapentin.

I believe these numbers are correct. The idea of taking hormones is mostly negative in the patients mind mostly because of breast cancer risk, Treatment for VMS needs to be individualized for each patient. We need to provide education on the true risk of hormones and breast cancer. Studies show it is not the estrogen that causes breast cancer but the progestins. I believe a shared decision model works best to help our patients navigate HRT for VMS. Estrogens work best for VMS. All others are trial and error and have varied responses based on the individual.

The difficult aspect of discussing therapeutics for VMS in menopause is the age range is large and thus the risks are variable. The biggest unmodifiable risk factors include CAD/CVD hx, VTE hx and hx of estrogen-sensitive malignant conditions. These all increase with age, so (generally speaking) treating a 42 year woman going through early menopause with estrogen is much less of a risk than treating a 63 year old woman. In older women or those who have elevated risk, I am more apt to use desvenlafaxine, gabapentin, duloxetine or paroxetine. In younger women with VMS who are still menstruating, combined oral contraceptives can be used.

Pendulum has definitely swung away from estrogen. The women’s health initiative study started this trend. My main stay therapeutic choices are evening primrose oil, black cohosh, Astro van, any soy type products. Definitely Effexor and other SSRIs can be helpful.

I agree. SSRI work well for me

I agree with the statistics. In mild to moderate cases, I prefer to try Black Cohosh and MACA before resorting to the other options but commonly have to go the next step.

Women are very often reluctant to start HRT. I do feel explaining the risk and recommending a low dose for a short duration aids in alleviating some of their fears. I also think women feel that suffering is part of the process and reframing this is very important.

I find that many SSRIs and SNRIs work well for hot flashes- wellbutrin and effexor or pristiq especially.

As an actively practising gynecologist and obstetrician, I see many women who have vasomotor symptoms which detract from their quality of life. The statistics noted are quite similar to those of my own practice. I discuss all associated symptoms especially local symptoms of estrogen deficiency as well as any contraindications to hormone use. If she is still having periods even if spread out and there are no contraindications to estrogen and she needs contraception, I will try her on a low dose oral contraceptive pill, most women get significant relief this way. If she has not had a period in more than one year, I will often prescribe sequential estrogen and at least 10 days of oral or vaginal progestin to follow and most women find good relief. If the woman has had a hysterectomy then oral estrogen is a prescription that I would give her. For women who will not take hormones or have contraindications to hormone use, I commence with Brisdelle or Desvenlafaxine both of which work well. Clonidine patch works for some and so does Gabapentin. Oher SSRIs or SNRIs work for some women. I counsel the woman up-front that we may need to change type of medication, depending on symptom response. Every woman is unique so what works for one may not work for another so pre-prescription counseling and setting realistic expectations is critical.

I am a nurse practitioner in an oncology practice. We treat breast and Gyn cancer patients. I feel these statistics are accurate. I have found Effexor and gabapentin to be helpful with vasomotor symptoms. Also SSRIs. Have also had women say black cohosh is helpful.

I see this quite often i have found clonidine and ssri’s help some

I work in Urgent care, I get patient in that age group, with symptoms, difficult to distinguish VMS symptoms from serious conditions like MI/PE etc.
however since I am family physician , I do advise them on various treatment available to treat the same, and ask them to follow with PCP

I am a family nurse practitioner, and approximately 25 to 30% of my practice is women’s health. I find VMS Difficult to treat with the vast majority of women. My largest complaint with women is mood, fatigue, and concentration, they don’t tend to mention sleep problems until I ask them. (Don’t forget the frequent complaints of new onset bloating and upper abdominal fat deposit- I call it the second panus)

I have tried patients on hormone replacement therapy, which is only successful in about 35 to 40% of my patients. I’ve tried combination of hormone replacement therapy with SSRI or SNRI, most women with that combination are happier with the hormone replacement therapy and the SNRI.

I know Paxil is highly recommended as an SSRI for VMS, However most women experience significant side effects from this medication and I tend to stay away from it.

I have recommended primrose oil supplement, layering clothing, sleep hygiene, and sleeping with a fan on at night to help with sleep issues which is only marginally effective. I also, recommend a little personal neck fan and Qbrexza (topically) for severe FACIAL VMS.

Interestingly, I have had some success with Glycopyrrolate, oxybutynin, and Botox. However Botox is not easily obtained for all women due to cost, and in our practice we only do cosmetic cash price.

I myself am interested in this I am 53 years old currently in my third year of menopausal symptoms VMS, Experiencing sleep difficulty, Fatigue, hot Flashes, night sweats, muscle weakness, bloating, vaginal dryness, and difficulty concentrating.

Yes this is what I see in my patients. I have also used SsRi therapy, but I have used gabapentin at bedtime for nocturnal hot flashes which does help.

I believe these numbers are in line with our current statistics. While we do not push HT as strongly as lifestyle modifications, the options are offered. I would say that even if able, many patients still chose to accept this part of life and are HT risk averse.

I don't think I see 1/3 where HT is actually contraindicated. I do think easily half are averse to any medical intervention. Patients must trust that we aren't pushing anything. My discussion always begins with lifestyle changes, stop smoking, limit alcohol and caffeine, moderate exercise, etc. If these help, not, then I encourage patients (or I give them permission) to use OTC remedies such as progesterone creams or black cohosh may help, even if it is a placebo effect. Only after this discussion can we really be certain patients are ready to make a decision on, or commit to actual hormone therapy.

Absolutely! In fact, those statistics are underestimated. It is rare to talk to a female patient in this age group or younger who is will not mention irritability, insomnia, low libido, weight gain, etc. HRT is helpful in some women, while SSRI such as Effexor or paroxetine work for others. Vaginal estrogen cream works well for almost all women with reported vaginal dryness or dyspareunia. It also decreases the frequency of UTIs and BV infections. Patients looking into natural supplements benefit from black cohosh and MACA.

These are accurate numbers. Mpst women just accept this as part of menopause and life. Pnly those with severe symptoms actually complain and ask for help. If hormones are contraindicsted i offer a variety of options including lifestyle and diet chznges. Also over the counter soy products. On occasion i try SSRIs Nd other off label medications. Sometimes they help but rarely are they very effective.

I agree paroxetine helps with hot flashes. Also recommend triggers for hot flashes, for example alcohol, caffeine, chocolate.

Paroxetine has been a good adjunct therapy for treating women who receive HRT and who are menopausal and perimenopausal that have hot flashes.

Black cohash at a high dose is useful I have found. It is worth a try for your patients.

I think these statistics are accurate but actual occurrence is higher. I feel women are embarrassed to discuss these symptoms. I often encourage pelvic floor therapeutics, hydration, topical agents such as coconut oil can be benificial.