Hypnosis, venlafaxine equally reduce hot flashes; combination not superior to either approach
Hypnosis may produce reductions in hot flashes similar to that achieved with venlafaxine, according to a study, although the combination of these two treatment approaches is not superior to either treatment alone.
The pilot study randomized 71 postmenopausal women to one of four treatment groups: venlafaxine 75 mg plus hypnosis (VH; n=15; mean age 56 years), venlafaxine 75 mg plus sham hypnosis (VSH; n=19; mean age 54 years), placebo pill plus hypnosis (PH; n=22; mean age 54 years) and placebo pill plus sham hypnosis (PSH; n=15; mean age 56 years). Treatment lasted 8 weeks.
All women kept a daily diary in which hot flash severity and frequency were recorded in real time. A General Estimating Equation model facilitated analysis of intrapatient difference in hot flash score (frequency x severity) at 8 weeks—the primary endpoint—using VSH as the referent arm and controlling for baseline hot flashes.
The primary endpoint did not statistically differ in the active treatment arms, PH and VH, when compared with the referent arm VSH (p=0.34 and p=0.05, respectively). Hot flashes decreased by about 50 percent in the PH and VH arms vs 25 percent in the PSH arm. Women in the PSH arm also reported statistically smaller reductions in hot flash score compared with those in the referent VSH arm (p=0.001).
No significant negative side effects were reported during the course of the study.
Hot flashes occur commonly in menopause, affecting up to 75 percent of women including those with a history of cancer. The symptom can be a significant source of bother and distress, negatively affecting quality of life and possibly leading to a loss of productivity. [Lancet 2002;360:1851-1861; Clin Obstet Gynaecol 2007;21:261-274; Climacteric 2015;18:456-469]
Aside from hormonal therapy and nonhormonal alternatives such as serotonergic antidepressants and the anticonvulsant gabapentin, behavioural therapy also shows potential in the management of hot flashes. [N Engl J Med 2016;374:803-806; J Clin Oncol 2002;20:1578-1583; Oncol 2009;27:2831-2837]
The current data provide evidence of the efficacy of hypnosis in the treatment of hot flashes, although more studies are needed to elucidate whether the intervention could be combined with a different low-dose pharmacologic intervention “to provide optimal relief of hot flashes synergistically without ceiling effects and without side effects, or to identify a population who could benefit more from such a combination,” researchers said.