The American College of Obstetricians and Gynecologists has released new guidance strongly recommending hormone therapy as a go-to treatment for hot flashes, night sweats and related sleep disturbances. The group made an exception for patients with contraindications such as a history of blood clots, stroke or certain cancers, for whom it recommended a wider range of alternatives than before.
The guidelines are similar to ones published last week by the American College of Physicians. ACOG's 2014 guidance also supported hormone therapy but urged doctors to prescribe the lowest effective dose for the shortest time. The new recommendations stress regular review of treatment and individual decision-making rather than a fixed rule on length or intensity. Dr. Catherine Cansino, chair of the ACOG committee, said flexibility is the goal. The guidance says therapy is best started before age 60 or within 10 years of menopause, though patients already taking it may need to continue past 60 to manage persistent symptoms.
Dr. Jo Ann Manson of Harvard Medical School, who was not involved in the guidance, said there is growing consensus that hormone therapy should be the first line of treatment. Use of hormone therapy has risen in recent years after plunging following findings from the Women's Health Initiative linking some forms to a small increase in breast cancer and cardiovascular risk. Only a small minority of women currently use it.
For patients at high risk, or those who prefer not to take hormones, the guidelines recommend a newer class of drugs that block certain brain receptors and some antidepressants that can reduce hot flashes and night sweats. Dr. Stephanie Faubion of the Mayo Clinic said the guidelines would benefit from more detail on risk thresholds, but called the recommendations "quite reasonable" overall.
Source: New York Times Top Stories · Summarized by HeadlinesBriefing