ACP puts hormone therapy first for menopausal hot flushes, with SNRIs next

The edition in brief

The American College of Physicians has issued a guideline on drug treatment for menopausal vasomotor symptoms, built on a review of 90 trials. It strongly recommends oestrogen, with a progestogen if the uterus is present, as first line on high-certainty evidence; desvenlafaxine or venlafaxine second; and escitalopram, paroxetine, gabapentin or a neurokinin receptor antagonist third. In a US trial of 3,220 underserved smokers referred for lung cancer screening, adding cash incentives for confirmed quitting raised six-month abstinence from 4.3% to 8.8%, while free medicines alone did not beat advice and referral. A Brazilian adaptive trial of 399 adults with long COVID fatigue found fluvoxamine lowered fatigue scores modestly versus placebo; metformin results were inconclusive. In ENERGIZE-T, oral mitapivat halved transfusion needs in 30% of adults with transfusion-dependent thalassaemia versus 13% on placebo. ROAM found radiotherapy after complete resection of atypical meningioma cut recurrence (5-year disease-free survival 79.9% vs 64.3%). The pearl covers checks before starting systemic oestrogen.