The 2023 nonhormone therapy position statement of The North American Menopause Society

Abstract

Objective To update the evidence-based Nonhormonal Management of Menopause-Associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society. Methods An advisory panel of clinicians and research experts in women’s health were selected to review and evaluate the literature published since the Nonhormonal Management of Menopause-Associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society. Topics were divided into five sections for ease of review: lifestyle; mind-body techniques; prescription therapies; dietary supplements; and acupuncture, other treatments, and technologies. The panel assessed the most current and available literature to determine whether to recommend or not recommend use based on these levels of evidence: Level I, good and consistent scientific evidence; Level II, limited or inconsistent scientific evidence, and Level III, consensus and expert opinion. Results Evidence-based review of the literature resulted in several nonhormone options for the treatment of vasomotor symptoms. Recommended: Cognitive-behavioral therapy, clinical hypnosis, selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors, gabapentin, fezolinetant (Level I); oxybutynin (Levels I-II); weight loss, stellate ganglion block (Levels II-III). Not recommended: Paced respiration (Level I); supplements/herbal remedies (Levels I-II); cooling techniques, avoiding triggers, exercise, yoga, mindfulness-based intervention, relaxation, suvorexant, soy foods and soy extracts, soy metabolite equol, cannabinoids, acupuncture, calibration of neural oscillations (Level II); chiropractic interventions, clonidine; (Levels I-III); dietary modification and pregabalin (Level III). Conclusion Hormone therapy remains the most effective treatment for vasomotor symptoms and should be considered in menopausal women within 10 years of their final menstrual periods. For women who are not good candidates for hormone therapy because of contraindications (eg, estrogen-dependent cancers or cardiovascular disease) or personal preference, it is important for healthcare professionals to be well informed about nonhormone treatment options for reducing vasomotor symptoms that are supported by the evidence.

Fezolinetant: A New Nonhormonal Treatment for Vasomotor Symptoms

“…However, the use of serotonin selective reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin, and oxybutynin is also supported in the guidelines to provide mild-to-moderate improvement in VMS. 4…”

Prevalence and impact of vasomotor symptoms due to menopause among women in Brazil, Canada, Mexico, and Nordic Europe: a cross-sectional survey

“…For example, paroxetine is approved for VMS in the United States, but it is not approved for VMS in Canada or Sweden, which are countries included in the current study. Modest efficacy of non-HT compared with HT, as well as concerns about safety and tolerability, may limit use of these agents 8,15,17,19 . Thus, many women seek nonprescription herbal treatments and dietary supplements, despite a lack of evidence of their efficacy and safety 12,15,18-20 .…”

“…Modest efficacy of non-HT compared with HT, as well as concerns about safety and tolerability, may limit use of these agents 8,15,17,19 . Thus, many women seek nonprescription herbal treatments and dietary supplements, despite a lack of evidence of their efficacy and safety 12,15,18-20 . In 2023, fezolinetant, a first-in-class neurokinin 3 receptor antagonist, was approved by the US Food and Drug Administration for treatment of moderate to severe VMS due to menopause 19,21 …”

It's time to wake up: vasomotor symptoms, poor sleep, and their relationship with adverse work outcomes

“…Hormone therapy remains the most effective treatment for VMS, and recent guidelines again highlight that the benefits outweigh the risks for most women without contraindications who are younger than 60 years or within 10 years from their final menstrual periods 4 . For women who cannot use hormone therapy, or for those who choose not to, there are multiple nonhormone options available, 15 including a novel therapeutic agent that targets the central mechanism that causes VMS, the neurokinin B receptor antagonist fezolinetant. Overcoming barriers to VMS treatment may not only improve the quality of life for women but may also mitigate against adverse work outcomes and potentially benefit society in terms of reduced economic burden linked with menopause symptoms as well as greater work productivity.…”