NAMS outlines alternative Tx for hot flashes: lifestyle changes.(Gynecology)

The first alternative to hormone therapy for treating hot flashes should be a lifestyle approach, such as instituting an exercise regimen or practicing controlled breathing techniques, according to a statement released last month by the North American Menopause Society.

The group's purpose in releasing the statement is to get clinicians to consider the use of alternatives to estrogen with or without progesterone for treating those patients who may have misgivings about hormone therapy and are willing to tolerate therapy that may be less powerful, said Dr. Nanette E Santoro, who is the chair of the committee that drafted the statement.

"There has been estrogen, and then everything else, and clinicians have rarely reached for those other things," said Dr. Santoro, director of the division of reproductive endocrinology at the Montefiore Medical Center in New York. "But we seem to have some reasonable alternatives, particularly with the SSRIs."

The statement reviews the evidence for several commonly used alternative treatments, as well as the use of hormone therapy. Many in the menopause-treatment community praised the document for what they called its meticulous completeness.

"I think every obstetrician-gynecologist ought to get hold of it and read it," said Dr. Jan Leslie Shifren, director of the menopause program of the Vincent Obstetrics and Gynecology Service at the Massachusetts General Hospital in Boston.

Lifestyle modifications are the alternatives that are recommended first and most strongly in the statement.

Observational studies show that lowering air temperature reduces hot flashes. Some other methods that women can use to keep cool include using a fan, dressing in layers so clothes can be removed easily, and consuming cold foods and drinks while avoiding hot ones.