Treatment of menopause-associated vasomotor symptoms:
position statement of The North American Menopause Society.
North American Menopause Society.
North American Menopause Society, Cleveland, OH 44101, USA.
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OBJECTIVE: To create an evidence-based position statement regarding the
treatment of vasomotor symptoms associated with menopause. DESIGN: The North
American Menopause Society (NAMS) enlisted clinicians and researchers
acknowledged to be experts in the field of menopause-associated vasomotor
symptoms to review the evidence obtained from the medical literature and
develop a document for final approval by the NAMS Board of Trustees. RESULTS:
For mild hot flashes, lifestyle-related strategies such as keeping the core
body temperature cool, participating in regular exercise, and using paced
respiration have shown some efficacy without adverse effects. Among
nonprescription remedies, clinical trial results are insufficient to either
support or refute efficacy for soy foods and isoflavone supplements (from
either soy or red clover), black cohosh, or vitamin E; however, no serious
side effects have been associated with short-term use of these therapies.
Single clinical trials have found no benefit for dong quai, evening primrose
oil, ginseng, a Chinese herbal mixture, acupuncture, or magnet therapy. Few
data support the efficacy of topical progesterone cream; safety concerns
should be the same as for other progestogen preparations. No clinical trials
have been conducted on the use of licorice for hot flashes. Among nonhormonal
prescription options, the antidepressants venlafaxine, paroxetine, and
fluoxetine and the anticonvulsant gabapentin have demonstrated some efficacy
for treating hot flashes and were well tolerated. Two antihypertensive agents,
clonidine and methyldopa, have shown modest efficacy but with a relatively
high rate of adverse effects. For moderate to severe hot flashes, systemic
estrogen therapy, either alone (ET) or combined with progestogen (EPT) or in
the form of estrogen-progestin oral contraceptives, has been shown to
significantly reduce hot flash frequency and severity. Clinical trials have
associated ET/EPT with adverse effects, including breast cancer, stroke, and
thromboembolism. Several progestogens (both oral and intramuscular
formulations) have shown efficacy in treating hot flashes, including women
with a history of breast cancer, although no definitive data are available on
long-term safety in these women. CONCLUSIONS: In women who need relief for
mild vasomotor symptoms, NAMS recommends first considering lifestyle changes,
either alone or combined with a nonprescription remedy, such as dietary
isoflavones, black cohosh, or vitamin E. Prescription systemic
estrogen-containing products remain the therapeutic standard for moderate to
severe menopause-related hot flashes. Recommended options for women with
concerns or contraindications relating to estrogen-containing treatments
include prescription progestogens, venlafaxine, paroxetine, fluoxetine, or
gabapentin. Clinicians are advised to enlist women's participation in decision
making when weighing the benefits, harms, and scientific uncertainties of
therapeutic options. Regardless of the management strategy adopted, treatment
should be periodically reassessed as menopause-related vasomotor symptoms will
abate over time without any intervention in most women.
Publication Types:
- Guideline
- Practice Guideline
PMID: 14716179 [PubMed - indexed for MEDLINE]
