Department of Internal Medicine, Alpert Medical School at Brown University, Providence, Rhode Island.
Department of Internal Medicine, Alpert Medical School at Brown University, Providence, Rhode Island.
Clin Ther. 2018 Oct;40(10):1778-1786. doi: 10.1016/j.clinthera.2018.08.010. Epub 2018 Sep 12.
Nonhormonal medications and complementary and alternative therapies are used by many women seeking relief from bothersome hot flashes. However, health care professionals may be less familiar with these treatment modalities. Although estrogen remains the most effective medication to reduce hot flashes, its potential harmful effects have led investigators to examine other treatments for hot flashes, and many women seek alternative forms of relief. Most of these trials are limited by a significant placebo effect, which frequently equals the effectiveness of the medication being evaluated. Despite this limitation, selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and gabapentin have robust evidence for hot flash reduction. Each of these may be chosen for additional treatmenteffects that may benefit some women. Complementary and alternative medication trials are fraught with additional limitations, namely, a large placebo effect, greater homogeneity of participants, lack of validated tools, and lack of robust reporting of adverse effects. The data appear most robust for isoflavone supplementation, with overall hot flash reduction similar to the SSRIs, SNRIs, and gabapentin. Mindfulness-based stress reduction therapy also has evidence of effectiveness and may be an ideal choice for some. Primrose oil, Chinese herbal medicine, acupuncture, and yoga have mixed results. The concerns related to hepatotoxicity preclude the use of black cohosh. Exercise, relaxation, and paced respiration have no proven benefit thus far in reducing hot flashes. Our goal with this commentary is to arm clinicians with information about the medications and complementary therapies available to provide symptom relief to women. Providing information about the possible benefits and harms of these therapies despite the limitations of the current evidence is helpful to patients and can help guide them to seek the treatment option most beneficial and appealing to them.
许多寻求缓解烦人的热潮红的女性会使用非激素药物和补充及替代疗法。然而，医疗保健专业人员可能对这些治疗方法不太熟悉。虽然雌激素仍然是减少热潮红最有效的药物，但它可能产生的有害影响促使研究人员研究其他治疗热潮红的方法，许多女性寻求替代缓解方法。这些试验大多受到明显的安慰剂效应的限制，这种效应通常与正在评估的药物的疗效相当。尽管存在这种局限性，但选择性 5-羟色胺再摄取抑制剂（SSRIs）、5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs）和加巴喷丁在减少热潮红方面有确凿的证据。这些药物中的每一种都可能因其额外的治疗效果而被选择，这些效果可能对一些女性有益。补充和替代药物试验存在更多的局限性，即安慰剂效应大、参与者同质性高、缺乏经过验证的工具以及缺乏对不良反应的可靠报告。补充异黄酮的数据似乎最为可靠，总体热潮红缓解效果与 SSRIs、SNRIs 和加巴喷丁相似。基于正念的减压疗法也有疗效的证据，可能是一些人的理想选择。月见草油、中药、针灸和瑜伽的结果喜忧参半。与肝毒性相关的担忧排除了黑升麻的使用。迄今为止，运动、放松和有节奏的呼吸对减轻热潮红没有明显的益处。我们撰写这篇评论的目的是为临床医生提供有关药物和补充疗法的信息，以缓解女性的症状。尽管目前的证据存在局限性，但提供有关这些疗法的可能益处和危害的信息对患者有帮助，并可以帮助他们选择最有益和最吸引他们的治疗方法。
