Cleveland Clinic Journal of MedicineStellate Ganglion Block as a Treatment for Vasomotor Symptoms: Clinical Application

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Vasomotor symptoms (VMS), including hot flashes and night sweats, affect up to 80% of women during menopause. Although hormone therapy remains the gold standard for treatment, stellate ganglion block (SGB) is gaining attention as a potential non-hormonal alternative. This review examines the current evidence supporting SGB’s use in managing VMS, particularly for women with severe symptoms who cannot use or choose not to use hormone therapy.

Key Points:

• VMS affects 60-80% of menopausal women, lasting an average of 7-9 years and significantly impacting quality of life.
• Hormone therapy reduces VMS frequency and intensity by 75-79% but is contraindicated for some women.
• Non-hormonal options include SSRIs, SNRIs, clonidine, gabapentin, and oxybutynin, each with varying efficacy and side effects.
• SGB involves injecting local anesthetic into cervical sympathetic ganglia, potentially modulating thermoregulatory areas in the brain.
• Clinical trials show SGB reduces VMS frequency by 4-90%, with few adverse events reported.
• The mechanism of action for SGB in treating VMS is not fully understood, with hypotheses involving peripheral vasodilation and neuromodulation.
• The North American Menopause Society recommends SGB with caution due to its invasive nature and limited long-term data.

“SGB is currently being used in women with severe VMS who cannot use hormone therapy or whose symptoms have not responded to other treatments. However, its use is limited by a lack of awareness, limited availability, and high cost (estimated to be $2,000 for a treatment course of 2 SGB injections).”

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