Since the Women’s Health Initiative (WHI) reported that the risks of menopausal hormone replacement therapy (HRT) outweighed its benefits, there has been a significant reduction in the use of HRT. However, recent studies have suggested that many peri- and postmenopausal women experience significant symptoms for many years and that these symptoms have a marked impact on the quality of life. While hormonal interventions may be considered in certain populations of women without significant risks, other women may not want or cannot use hormonal treatments.
The North American Menopause Society has published its position statement regarding the management of menopause-related vasomotor symptoms (full text available free through Medscape). Eleven years have passed since NAMS issued its last position statement on the management of VMS, and the new report is a very through review of the current research and definitely worth reading. The following is a summary of the NAMS recommendations:
Recommended: Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing VMS. Paroxetine 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, gabapentin, and clonidine show evidence of efficacy.
Recommend with caution: These therapies may be beneficial for alleviating VMS: weight loss, mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but further evaluation of these therapies is warranted.
Do not recommend at this time: There are negative, insufficient, or inconclusive data regarding the following therapies and thus cannot be recommended for the management of 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. While there is insufficient or conflicting data regarding certain interventions, such as yoga and exercise, the authors note that these interventions could improve overall quality of life and may have other health benefits.
Given the prevalence of vasomotor symptoms in midlife women, and the impact of these symptoms on quality of life, psychological well-being, and functioning, clinicians need to be well informed about the wide array of nonhormonal treatment options currently available and the evidence supporting their use in this setting.
Ruta Nonacs, MD PhD
Nonhormonal Management of Menopause-associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society. Menopause. 2015 Nov;22(11): 1155-72; quiz 1173-4.