(134) EFFECTIVE TREATMENT OF MENOPAUSAL HOT FLASHES IMPROVES DOWNSTREAM FEMALE SEXUAL COMPLAINT
Authors: Krychman M , Javaid S , Nezolosky M , Suozzi N 
Published: June 2024

Abstract

Introduction
Approximately 75% of women aged between 45 years and 55 years suffer from symptoms of menopause. Untreated hot flashes have many downstream effects including but not limited to fatigue, low energy, memory complaints, lowered libido, sexual dysfunction and may even be linked to increased cardiovascular disease. While the gold standard for effective treatment is hormonal therapy, many women (especially those with a family history of breast cancer) may decline their use due to concerns regarding efficacy and safety. Lack of sensitivity training and level of comfort to disclose menopausal symptoms is often a significant barrier to effective treatment. Dose optimization, close surveillance of efficacy of hormone utilization is essential to maintain patient compliance.

Objective
Menopausal hot flashes are associated with a variety of downstream sexual complaints including lowered libido. This retrospective study was done to assess if optimal treatment of hot flashes with hormones and over the counter products would have a downstream effect on concurrent reported sexual complaints.

Methods
A retrospective review of a random convenience sample was conducted to assess women who presented with complaints of hot flashes. Concurrent associated symptoms were also reported. Treatment interventions and symptom resolution was evaluated. Data was collected and stored in private HIPPA protected database.

Results
A random convenience sample (n=56) from the HerMD centers (Cincinnati and Kentucky) was assessed for women (mean age 51.3; range 30-73) who presented with complaints of hot flashes. Associated symptoms included: brain fog/memory complaints (66%); sleep disturbances including insomnia (59%), decreased libido (49%), weight management concerns (38%), vaginal dryness (31%) and dyspareunia (14%). A family history of breast cancer was present in 18% of the sample. Treatment included: behavioral intervention counseling (100%), over the counter supplements n=2, (3.5%) and systemic hormonal therapy n=54 (96.5%) and over the counter recommendations (100%). All patients (100%) with a family history of breast cancer received hormonal therapy. Overall, 96% of patients responded to their intervention with self-reported improvement in hot flashes, and improvement in dyspareunia, vaginal dryness and improved libido at scheduled follow up visits. Patients had multiple office/telehealth visits to ensure dose optimization, efficacy of symptom resolution and ensure no treatment emergent adverse effects. There were n=3 (5%) reported adverse effects (minimal vaginal spotting) yet no patients discontinued treatment

Conclusions
Hot flashes are associated with a variety of sexual complaints including but not limited to decreased libido (49%), vaginal dryness (31%) and dyspareunia (14%). Optimal treatment of hot flashes will have downstream efficacy with FSD complaints. At HerMD, HCP have internal continuing menopausal medical education which includes standardized clinical algorithms, bibliotherapy, article data base, 1-1 didactic education/supervision and preceptorships with national menopausal experts. Systemic hormones will help with vaginal dryness and dyspareunia. HerMD advocates close clinical surveillance with treatment efficacy and safety review which allows for interventions to be modified henceforth allow for outcome optimization and enhance compliance.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Michael Krychman is a consultant for exeltis pharmaceuticals, Astellas, Uberlube and CEEK.