A Needle Saves the Day! And Other Myths…
The North American Menopause Society (NAMS) crafts the guidelines that inform and influence the advice we get from our doctors regarding menopause, so naturally I am pretty interested in what they have to say. I’ve mentioned before how disappointed I am in their 2017 position paper, which touts the “effectiveness and favorable benefit” of hormone therapy above all other solutions in the management of menopause – so when I saw that there was an app available I quickly downloaded and tried it out, hoping that they had finally seen the light and updated that position.
Nope. In fact, it’s quite the opposite.
The app makes clear right off what NAMS thinks of anything not requiring a prescription pad with this question: “have you tried behavioral/lifestyle modifications for at least three months without adequate response?” There is a link to email yourself a list of lifestyle modifications, which is two pages long and includes about 250 words describing how “staying cool and reducing stress are the principal lifestyle changes to treat your hot flashes.” It then goes on to describe how if any of these changes DO work, it is likely due to the placebo effect – and a helpful list of prescription therapies follows.
So, back to the app I guess, since there don’t appear to be ANY non-medical solutions to what I’m feeling. I mean, why would I waste my time with something that just offers a placebo effect? (By the way, nice use of psychology to make us feel stupid for even considering “lifestyle changes” and quickly fall into line to ask for the prescription, NAMS.) Once you’re done with that little sidebar of useless alternative therapies and are ready for the real stuff, the app leads you through a series of 10 questions around potential risk factors like diabetes and high blood pressure before doubling down on advising some form of medical intervention. Depending on how you answer the questions, you are led down one of three paths:
“women with an intact uterus on HT should take combination estrogen plus progestogen (E+P).”
“non-hormonal medications for hot flashes such as SSRI/SNRI antidepressants”
“other non-hormonal medications for hot flashes such as gabapentin, pregabalin, or clonidine”
I know that there are many off-label uses for prescription medications, some of which can be life-saving. But in this case, prescribing an anticonvulsant used for nerve pain like gabapentin should give us pause when we consider that the side effects (dizziness, fatigue, irritability, viral infections, tremors, edema…) actually read worse than the problem it is supposed to treat.
Same goes for clonidine, which is typically used for treating high blood pressure – the reasoning for using it here is that it improves blood flow and therefore helps hot flashes, but COME ON – this can be achieved more easily and without the side effects of headache, fatigue, constipation and nausea just by slightly altering your diet.
And the antidepressants? Don’t get me started. If you are actually depressed, yes – by all means, get the prescription from your mental health provider! But for hot flashes? Think again – studies like this one have shown that SSRIs reduce the frequency of hot flashes, but “improvement in hot flashes, although statistically significant, is modest and likely has questionable clinical significance.” What does have significance? The side effects of nausea and loss of libido. Funny, because despite these findings, the conclusion of the study actually recommends SSRIs as an alternative to HRT. Go figure.
Back to the app. If you don’t choose any of these three courses of action, you are offered one last option:
“If you have severe and resistant symptoms, other less well-established treatments including stellate ganglion blockade may be options.
Have you ever heard of this? I hadn’t, so I looked it up. A stellate ganglion block is an injection to block the sympathetic nerves in the neck. WTF??? I dug a little more and found this study, which describes the researchers’ hypothesis that a stellate ganglion block may work as treatment for hot flashes based on 11 articles describing other researchers’ hypotheses. Oh, okay then – that sounds pretty conclusive. I’d much rather have a needle in the neck than I don’t know, getting healthy from the inside out, changing my diet a little and maybe going to yoga once a week!
Why aren’t more women mad about this?
When you see the official guidance from the organization that bills itself as “the preeminent resource on all aspects of menopause to both healthcare providers and the public” and the supporting research that our doctors rely on, it is obvious why we are so aggressively pointed in the direction of HRT and other prescription medications when we ask for help managing our physical issues during menopause.
But why are we so willing to go along with it? Why don’t we question advice that defies logic, overlooks simple, natural solutions free from side effects, and endangers our health? Modern medicine is failing us. Feeling better does not require a prescription – there are real strategies for eliminating the discomfort women often feel during menopause that are simple to incorporate into your life and pay long-term dividends in terms of longevity, disease prevention, and overall health. THIS should be the first line of defense, not medication.
We must take back the reigns of our health. The sooner the better.