Nonhormonal management of menopause-associated vasomotor symptoms

Abstract

Clinicians need to be well informed about the level of evidence available for the wide array of nonhormonal management options currently available to midlife women to help prevent underuse of effective therapies or use of inappropriate or ineffective therapies. Recommended: Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing VMS. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS, although other selective serotonin reuptake/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine show evidence of efficacy. Recommend with caution: Some therapies that may be beneficial for alleviating VMS are weight loss, mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but additional studies of these therapies are warranted. Do not recommend at this time: There are negative, insufficient, or inconclusive data suggesting the following should not be recommended as proven therapies for managing VMS: cooling techniques, avoidance of triggers, exercise, yoga, paced respiration, relaxation, over-the-counter supplements and herbal therapies, acupuncture, calibration of neural oscillations, and chiropractic interventions. Incorporating the available evidence into clinical practice will help ensure that women receive evidence-based recommendations along with appropriate cautions for appropriate and timely management of VMS.

Design of a randomized controlled trial of Internet-based cognitive behavioral therapy for treatment-induced menopausal symptoms in breast cancer survivors

“…Cognitive behavioral therapy (CBT) is the only type of behavioral intervention with level 1 efficacy evidence for both women with naturally occurring and treatment-induced menopause. Use of CBT has been recommended by the North American Menopause Society [47]. …”

Prevalence and predictors of complementary and alternative medicine/non-pharmacological interventions use for menopausal symptoms within the UK Collaborative Trial of Ovarian Cancer Screening

“…It is likely that this may reverse the cycle of falling MHT and increasing CAM/NPI use. Currently, the North American Menopause Society only recommends cognitive behavioral therapy and clinical hypnosis as non-hormonal, non-medicinal approaches for menopausal symptom relief 45 .…”

Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature

“…Since that time this hypothesis has been hotly debated. Equol does appear to offer health benefits over its precursor daidzein [82,83] in possibly several different areas but especially in the alleviation of hot flashes [84,85,86]. However, it also may be that in some cases it is the equol-producing phenotype (i.e., the ability to produce equol) rather than equol itself, that is responsible for the more beneficial response to isoflavone ingestion [87].…”

“…Rodents and non-human primates have been referred to as equol machines because of their ability to so efficiently produce such large amounts of equol in response to daidzein exposure [9]. Several excellent reviews of equol have recently been published [80,82,86,88]. …”