Our Review Summary
This story provides a good overview of a meta-analysis of non-hormonal treatments for bothersome hot flashes in menopausal women. Dr. Heidi Nelson, the lead author of the study, appropriately cautions the reader that these treatment options were for women who were very bothered by hot flashes, and that hot flashes and other symptoms of menopause are a normal part of aging, so not everyone needs to take a prescription. While this is an appropriate caveat, lifestyle changes as non-hormonal treatment (e.g. dressing in cool, layered clothing, exercise, not smoking) are either not mentioned, in the case of smoking, or dismissed as ineffective for many women.
The number and severity of hot flashes varies by woman, and these hot flashes can be experienced as more severe by some women and not very bothersome by others. As the article reports, about 50% of women have hot flashes during menopause and of these, only 20% seek treatment. The story does an excellent job presenting the results of the JAMA article and discussing the efficacy of both hormonal and non-hormonal treatments along with warnings about the potential side effects for each option and the lack of long-term data on these medications for treatment of hot flashes. There is an appropriate comparison of the average reduction in hot flashes with hormonal and non-hormonal treatments.
Most medications discussed here are available with a prescription, but they are not currently FDA approved for the treatment of hot flashes. There is no mention of the cost of either hormonal or non-hormonal treatments, which would be important information if these drugs are to be taken daily (or several times a day for some medications) for months or even years.
Natural supplements such as soy and red clover were not very effective as treatments for hot flashes, though they are available without a prescription. These supplements are not regulated and their active ingredient (i.e. plant estrogens) may vary by manufacturer, which is not mentioned in the story. These supplements have not been studied as well as prescription hormone therapy and they may have some of the same negative health effects as hormone therapy. Also, these plant estrogens should not be taken by women with a history of breast cancer.
Criteria
Not Satisfactory
No mention of the cost of hormonal or non-hormonal treatments, which would be important to note if they are taken daily (or several times a day for some medications) for several months or years.
Satisfactory
Absolute reduction in number of hot flashes per day is presented for non-hormonal treatments and these are compared to the number of hot flashes with hormone treatment.
Satisfactory
Mentions side effects of the non-hormonal treatment under study, as well as the risks associated with hormone replacement therapy. There is no mention of the incidence of these side effects. However, this was a meta-analysis of 43 studies, so side effects varied by medication and each study.
Satisfactory
There is adequate description and some evidence presented from this meta-analysis of non-hormonal treatments to reduce the number and severity of bothersome hot flashes.
Satisfactory
Does not appear to be disease mongering. In fact, the closing line addresses this issue head-on: “We hate to medicalize a natural process,” Dr. Nelson said, but she added that severe symptoms should not be dismissed. “We want to take it seriously, but not everybody needs to be on prescription drugs for it.”
Satisfactory
The study was not funded by any of the drug manufacturers with medications under study in the review. Principal investigators have no financial ties to drugs mentioned in the study, though the story does not mention this.
Satisfactory
Satisfactorily presents several non-hormonal options for treatment. However, lifestyle related non-hormonal treatment (e.g. cool, layered clothing, exercise, not smoking) is either not mentioned or presented as ineffective options for women with hot flashes.
Satisfactory
Medications listed in the story are available with a prescription, but they are not yet FDA approved for the treatment of hot flashes. Supplements such as soy and red clover are available without a prescription, however, these are not regulated and the active ingredient (i.e. plant estrogens) in these supplements may vary by manufacturer.
Satisfactory
The story notes that the use of anti-depressants and certain blood pressure and anti-seizure medications as non-hormonal treatment for hot flashes is not new. However, these prescription medications are not yet FDA approved for this treatment.
Not Applicable
Not enough information to determine if this relies on a JAMA press release. Language is very similar to the introduction of the journal article and only study authors and the physican who wrote a JAMA editorial on the study are cited.
Total Score: 8 of 9 Satisfactory
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