Evidence-based Pharmacy Practice (EBPP) : hot flushes

Abstract

Hot flushes are the most common complaint of perimenopausal and postmenopausal women. Menopausal hormone therapy (HT) is the most effective treatment for vasomotor symptoms and improves the quality of life of women in which these symptoms can be distressing and incapacitating. Non-hormonal medical treatments for the management of vasomotor symptoms are less effective than oestrogen and evidence of efficacy is conflicting. Non-hormonal therapies include clonidine, SSRI's (Selective Serotonin Reuptake Inhibitors) and SNRI's (Serotonin Noradrenaline Reuptake Inhibitors) and gabapentin. Concerns about the safety of oestrogen-based HT after publication of the Women's Health Initiative Study and the Million Women Study has led many women to take alternative therapies, erroneously believing they are safer and 'more natural'. Pharmacists need to be able to give women appropriate advice so they can make an informed decision on whether or not to take or continue taking HT. Advice on non-pharmacological treatments, CAM's (complementary and alternative medicines) and non-hormonal treatments will also benefit women unable to (such as patients diagnosed with breast cancer) or unwilling to take HT. Pharmacists can help improve negative attitudes to the menopause and its symptoms by being knowledgeable and approachable on the subject. Women should be reassured that taking short term HT for the management of menopausal symptoms is a safe and therapeutic treatment for the majority of women.