In part two of my interview, Dr. JoAnn V. Pinkerton, Medical Director of the Midlife Health Center and Professor of Obstetrics and Gynecology, University of Virginia, addresses the concerns of patients currently taking PRISTIQ for depression. What does this mean for patients who develop moderate to severe hot flashes?

Q: For women currently taking PRISTIQ for depression, and finding themselves dealing with hot flashes will they require or even be allowed to have a dosage adjustment? Or will they need to seek alternative treatment options for their hot flashes?

Dr. JP: “In our study, we examined a range in the dosage of PRISTIQ from 50 mg to 200 mg. The findings indicate that a dosage of 100 mg was best in terms of balancing benefits and side effects. Generally, this preferred dosage level is common for PRISTIQ patients being treated for depression.

For someone currently taking less than 100 mg who is having hot flashes, we can look at increasing the dosage to 100 mg. For those women already taking 100 mg, to help prevent increased risk of adverse side effects, we can look into options. This might include estrogen therapy or alternatives that would be best for that individual, including simple steps such as layered clothing and ways to staying cool right up to the possibility of acupuncture.”

Q: Women concerned about side effects or seeking ‘natural’ alternative therapy options, what is your general approach to your patients who are leery of traditional HRT treatments?

Dr. JP: “Herbal products may or may not be better than placebos or non-treatments, but the problem we face now is that there are limited studies and limited results. Many of these alternatives may be promising but we have efficacy issues; we do not know the real results of short- and long-term treatment.

Until we have proven products, it is hard to recommend over the counter options. As physicians we must be cautious because our patients and we do not know what is in these products (Editor’s note: this is an unregulated industry at present in the US and many countries) and how safe or effective they may be with fluctuating ingredient levels. Women do not necessarily know what they are getting when they buy these products and we lack the randomized studies to back up any claims.”

Q: Patients come to your office inundated with information and may be confused because there is so much out there. How to you work with these women to help navigate the treatment options? As patients, what should women be doing to be more proactive in their healthcare?

Dr. JP: “Issues such as sleeping well, depression, and anxiety for example become more problematic during menopause due to the hormonal fluctuations. Menopause is a whole spectrum that we have to look at and help our patients in all areas of their healthcare.

In addition to the items mentioned earlier, we also want to explore women’s marital or relationship issues with partners and family members to see if there are any links or causes of mood issues. Menopause is complicated and exciting. And today’s multiple options both hormonal and non-hormonal mean women and their healthcare providers can chart a course for health aging.

**Important disclaimer: PRISTIQ is currently under review with the FDA for the treatment of hot flashes and is not yet approved for this indication.**

The third part of our interview concludes with Dr. Pinkerton and her approach to women’s healthcare. She explains why taking control of your health during menopause is so important.

A very special thank you to Dr. Joann V. Pinkerton for our recent telephone interview May 13, 2011.

Menopause, Your Doctor, and You