What is the first-line therapy for moderate to severe VMS?

What is the first-line therapy for moderate to severe VMS?

• A. Hormone therapy
• B. Nonhormonal pharmacologic therapy
• C. SSRIs
• D. Vaginal estrogen

Answer: (A)

Systemic hormone therapy is the preferred first-line approach for moderate to severe vasomotor symptoms because it provides the most effective and fastest relief from hot flashes and night sweats. Estrogen acts directly on the hypothalamic thermoregulatory center, reducing both frequency and intensity of symptoms. If the uterus is present, a progestin is added to protect the endometrium; if the patient has had a hysterectomy, estrogen alone is appropriate. While nonhormonal options (such as certain antidepressants, gabapentin, or clonidine) can help and are used when hormones aren’t suitable, they generally offer less robust symptom control and may have different side effects. Vaginal estrogen helps with vaginal and urinary symptoms but does not reliably relieve systemic vasomotor symptoms, so it isn’t considered first-line for VMS.

Systemic hormone therapy is the preferred first-line approach for moderate to severe vasomotor symptoms because it provides the most effective and fastest relief from hot flashes and night sweats. Estrogen acts directly on the hypothalamic thermoregulatory center, reducing both frequency and intensity of symptoms. If the uterus is present, a progestin is added to protect the endometrium; if the patient has had a hysterectomy, estrogen alone is appropriate. While nonhormonal options (such as certain antidepressants, gabapentin, or clonidine) can help and are used when hormones aren’t suitable, they generally offer less robust symptom control and may have different side effects. Vaginal estrogen helps with vaginal and urinary symptoms but does not reliably relieve systemic vasomotor symptoms, so it isn’t considered first-line for VMS.