Shot of anesthetic in neck eases symptoms in study
A shot in the neck may curb extreme hot flashes associated with menopause, a small new study suggests.
Injecting a local anesthetic into an area of the neck that communicates with the brain’s temperature regulation zone was associated with a 50 percent reduction in hot flashes among women with moderate to severe symptoms, the researchers reported.
Since research over the last decade has suggested that taking hormone replacement therapy to control menopausal symptoms may be associated with increased risk for heart disease and cancer, many women have been searching for a safe and effective nonhormonal means of reducing hot flashes.
The anesthetic treatment isn’t designed for everyone with hot flashes. It’s intended for those struggling with truly troubling hot flashes that occur regularly, affecting quality of life, said study author Dr. David Walega, chief of the division of pain medicine at Northwestern University Feinberg School of Medicine in Chicago.
“This is for people with multiple drenching sweats, women who can’t function in the workplace, who have extreme anxiety preceding the hot flash. And when that happens several times a day, we also see anxiety and depression,” explained Walega. Some women with breast cancer stop taking their medication — tamoxifen — because it can cause hot flashes, he added.
Hot flashes are sudden feelings of heat or warmth starting in the face and extending to the neck and chest area, sometimes accompanied by sweating and flushing of the skin. They are associated with menopause but can also occur in patients taking estrogen-blocking medications, typically for breast or prostate cancer. Walega estimated that hot flashes affect more than 80 percent of menopausal women.
To deliver the treatment, the physician uses guided imaging to inject a local anesthetic into what is called the stellate ganglion, an area between the thyroid gland (around the “voice box”) and the carotid artery.
The study was presented at the American Society of Anesthesiologists annual meeting in San Francisco.
The researchers found that stellate ganglion blockade reduces the incidence of hot flashes by half, especially in women with moderate or severe hot flashes, and the benefits appear to last for at least six months. Subjects also reported experiencing less depression after getting the anesthetic injections, and they demonstrated improved verbal recall of spoken words.
Dr. Grace Forde, a pain management specialist at Syosset Hospital in New York, noted that a large percentage of the patients receiving the placebo (injection) also reported an improvement in their hot flashes. “Invasive procedures often have a much stronger placebo effect,” she noted. Forde, who was not associated with the study, said she thinks the benefits of the treatment probably outweigh the risks. “You can’t put a price on quality of life. I personally think it’s worth it.”
FDA approves new drug
The U.S. Food and Drug Administration has approved the once-a-day tablet called Duavee to treat menopause-related hot flashes and potentially prevent osteoporosis in post-menopausal women who have a uterus, according to the drug’s manufacturer, Pfizer Inc.
When prescribed just for the prevention of osteoporosis in post-menopausal women, Duavee should only be considered for women at significant risk, and non-estrogen medication should be considered first, Pfizer advised.
The approval was based on phase 3 clinical trials that included generally healthy, post-menopausal women with a uterus. One study found that women taking the drug had 74 percent fewer moderateto-severe hot flashes after 12 weeks of treatment, compared with a 47 percent reduction among women who took a placebo, Pfizer said.
In other trials, women who took Duavee showed increased levels of bone mineral density in the hip and lumbar spine after one and two years of treatment, while women in the placebo group had decreased levels, the drug company said.