The Curbsiders Internal Medicine Podcast #409 Hormonal and Nonhormonal Therapy for Vasomotor Symptoms of Menopause
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Sep 25, 2023 Dr. Monica Christmas from University of Chicago Medicine joins to discuss hormonal and nonhormonal therapy for vasomotor symptoms of menopause. They cover nonpharmacologic management of symptoms, taking a history for menopausal symptoms, hormone therapy risk assessment and prescribing, troubleshooting hormone therapy, premature menopause, and discontinuation of hormone therapy.
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Begin With Lifestyle And Self‑Soothing
- Start menopause care with lifestyle changes and validate patient experience before pharmacologic therapy.
- Offer CBT/hypnosis, weight loss, Mediterranean diet, and cooling strategies as first-line measures.
Use CBT And Simple Cooling Techniques
- Teach brief CBT-style techniques (deep breathing, cooling, reframe anxiety) to reduce hot flash severity in clinic.
- Recommend CBT or guided hypnosis when available, noting online options can increase access.
Offer Nonhormonal Medication Options
- For patients avoiding hormones try SSRIs/SNRIs, gabapentin, or fezolinetant depending on symptoms and comorbidities.
- Counsel about modest efficacy, side effects, insurance/cost limits, and baseline liver tests for fezolinetant.