February 11, 2014 — The American Congress of Obstetricians and Gynecologists has revised its guidelines for the treatment of menopause symptoms, particularly for hot flashes and vaginal atrophy, the New York Times' "Well" reports.
The guidelines, which were published as a practice bulletin, update treatment recommendations based on the best available evidence, including studies regarding the once-commonly recommended estrogen supplementation.
According to "Well," estrogen supplementation fell out of favor after 2002, when a large clinical trial called the Women's Health Initiative found the treatment increased women's risks of blood clots, stroke, breast cancer and heart disease.
The report found that the "most effective therapy" for hot flashes is hormone therapy involving estrogen on its own or in combination with natural or synthetic progesterone in women who have not had a hysterectomy. "Data do not support the use of progestin-only medications, testosterone or compounded bioidentical hormones," the report said.
The report noted that treatment should be tailored to each patient and that physicians should prescribe the lowest doses of hormones over the shortest time that will work for the patient. The guidelines also recommended against the "routine discontinuation of systemic estrogen at age 65."
In addition, the report "found little or no data to support the use of herbal remedies, vitamins, phytoestrogens ... or acupuncture" for relieving symptoms, but recommended "'common sense lifestyle solutions' like dressing in layers, lowering room temperatures, consuming cool drinks, and avoiding alcohol and caffeine." The report also suggested that overweight women should try to lose weight to help relieve hot flashes.
The report also said hormone therapy may be used to treat vaginal atrophy. It noted that many women can relieve vaginal atrophy symptoms by using lubricants and moisturizers containing silicone or water, as well. In addition, the report noted that FDA last year approved the drug Osphena to treat vaginal atrophy, although the drug is not recommended for women with breast cancer, or for long-term use (Brody, "Well," New York Times, 2/10).