Key Feature 5: When a patient has contraindications to hormone-replacement therapy (HRT), or chooses not to take HRT: Explore other therapeutic options and recommend some appropriate choices
Skill: Clinical Reasoning, Patient Centered
Key Feature 6a: In menopausal or perimenopausal women: Specifically inquire about the use of natural or herbal products.
Skill: Clinical Reasoning, Selectivity
Key Feature 6b: In menopausal or perimenopausal women: Advise about potential effects and dangers (i.e., benefits and problems) of natural or herbal products and interactions.
Skill: Clinical Reasoning
Hormone replacement therapy used to scare people. Older studies showed there was a significantly greater risk of adverse cardiovascular outcomes for women at risk, but the women looked at in these studies were quite far along past the menopausal transition - in their 70s or so. Newer evidence has shifted current thinking, and with the advent of the estrogen patch to further decrease risk, many women are now candidates who were previously shunned from the benefits of hormone replacement therapy for the treatment of distressing menopausal symptoms. There are still some reasons, however, for which hormone replacement therapy is contraindicated, or for which symptoms are too mild to be considered worth it for the patient to start this treatment, or for women who do not want to assume the risks of hormone therapy that do exist even if relatively small, and women should be assisted to understand the other effective options that are available for the treatment of bothersome hot flashes and vulvovaginal atrophy. Explaining the other options that are available to treat menopausal symptoms is also indicated in obtaining good informed consent for hormone therapy, so women know there are other options to consider even if they present to clinic thinking this is what they want.
Below is the information I've amassed about non-hormonal therapy treatment options per UpToDate:
For women with mild hot flashes:
Many women who are bothered by the symptoms secondary to menopause may already be trying their own alternative herbs remedies. It is important to ask about this, as there are a lot of natural remedies that women use. Furthermore, if something is strong enough to have an impact on symptoms, it's certainly possible to be having side effects and it's worth keeping on your radar as their physician, as for any patients in general who take herbal supplements. Like fad diets, there is no shortage of herbal remedies purported to treat symptoms and disease processes. Sometimes the evidence is in favour of them, sometimes it is not, and sometimes it is inconclusive. While training to learn the basics of Family Medicine and the number of medications and all of their possible side effects and risks, recommended dosages and drug interactions, I simply cannot prioritize taking on the vast compendium of herbal therapies out there in the ether. However, it is my duty to look things up as patients inquire or confide in me that they are using them, and then to counsel them on what is known based on the evidence that is available. Although I can't be expected to be aware of treatments that are uncommon and that I don't personally prescribe or recommend, helping patients to make choices that are as informed as possible, while taking into account their values and preferences, is always my role as their family physician.