Stellate ganglion block as adjunct therapy for vasomotor and psychological symptoms in menopause and perimenopause: a case report

Stellate ganglion block (SGB) modulates the cervical sympathetic system and has been used in chronic pain, anxiety, and sleep disturbances. Emerging evidence suggests its benefit in controlling vasomotor and mood symptoms related to menopause. We present the case of a 53-year-old woman with prior hysterectomy for endometrial adenocarcinoma who presented with 8-10 daily hot flashes, generalized anxiety, and insomnia, Pittsburgh Sleep Quality Index (PSQI 14), refractory to non-hormonal pharmacotherapy. An ultrasound-guided SGB at C6-C7 using ropivacaine and dexmedetomidine was performed. At 2-week follow-up, hot flash frequency decreased to 1-2 daily episodes, and PSQI improved to 6, with substantial subjective improvement in anxiety. Ipsilateral Horner’s syndrome confirmed successful sympathetic blockade. We conclude that ultrasound-guided SGB was a safe and well-tolerated adjuvant intervention associated with clinically meaningful improvement in vasomotor and psychological symptoms in this patient with contraindications to hormone therapy. Prospective controlled studies are warranted to establish its efficacy and optimal patient selection criteria.