hot flashes

Vasomotor symptoms are the most widely recognized menopause symptoms in Western nations, with at least 75% of women reporting hot flashes or night sweats during or after the menopause transition. Many women struggle to choose between treatments, given lack of data on direct comparisons of different treatments, concerns about short-term adverse effects and longer-term treatment risks, and confusion about complementary or alternative remedies with unclear evidence of benefit.

Author/s:

Alison J Huang, Stephanie Faubion, Deborah Grady

Management of Menopausal Symptoms: A Review

Aubrey Delammermore — Wed, 08 Feb 2023 06:00:00 +0000

Date Added:

February 8, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

February 7, 2023

Issue:

Volume:

329

Pages:

405-420

URL:

Management of Menopausal Symptoms: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2022.24140

Keywords

sweat

Acetates

Cardiovascular Diseases

Progestins

menopause

PMID (1):

36749328

MeSH

A review of what we know and the current official recommendations regarding assistance with menopausal symptoms. James W. Mold, MD, MPH.

Free full text

View

Importance: Menopause, due to loss of ovarian follicular activity without another pathological or physiological cause, typically occurs between the ages of 45 years and 56 years. During the menopausal transition, approximately 50% to 75% of women have hot flashes, night sweats, or both (vasomotor symptoms) and more than 50% have genitourinary symptoms (genitourinary syndrome of menopause [GSM]).

Observations: Vasomotor symptoms typically last more than 7 years and GSM is often chronic. Efficacious treatments for women with bothersome vasomotor symptoms or GSM symptoms include hormonal and nonhormonal options. Systemic estrogen alone or combined with a progestogen reduces the frequency of vasomotor symptoms by approximately 75%. Oral and transdermal estrogen have similar efficacy. Conjugated equine estrogens (CEE) with or without medroxyprogesterone acetate (MPA) were the only hormonal treatments for which clinical trials were designed to examine cardiovascular events, venous thromboembolism, and breast cancer risk. Compared with placebo, the increased risk of stroke and venous thromboembolism associated with CEE (with or without MPA) and breast cancer (with use of CEE plus MPA) is approximately 1 excess event/1000 person-years. Low-dose CEE plus bazedoxifene is not associated with increased risk of breast cancer (0.25%/year vs 0.23%/year with placebo). Bioidentical estrogens approved by the US Food and Drug Administration (with identical chemical structure to naturally produced estrogens, and often administered transdermally) also are available to treat vasomotor symptoms. For women who are not candidates for hormonal treatments, nonhormonal approaches such as citalopram, desvenlafaxine, escitalopram, gabapentin, paroxetine, and venlafaxine are available and are associated with a reduction in frequency of vasomotor symptoms by approximately 40% to 65%. Low-dose vaginal estrogen is associated with subjective improvement in GSM symptom severity by approximately 60% to 80%, with improvement in severity by 40% to 80% for vaginal prasterone, and with improvement in severity by 30% to 50% for oral ospemifene.

Conclusions and relevance: During the menopausal transition, approximately 50% to 75% of women have vasomotor symptoms and GSM symptoms. Hormonal therapy with estrogen is the first-line therapy for bothersome vasomotor symptoms and GSM symptoms, but nonhormonal medications (such as paroxetine and venlafaxine) also can be effective. Hormone therapy is not indicated for the prevention of cardiovascular disease.

Author/s:

Crandall, C. J., Mehta, J. M., Manson, J. E.

Menopausal Hormone Therapy

Tracy Ashby — Thu, 30 May 2019 05:00:00 +0000

Date Added:

June 5, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

May 30, 2019

URL:

Menopausal Hormone Therapy

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2019.5346

Keywords

MeSH

A concise review of post-menopausal hormonal therapies. James W. Mold, MD, MPH

Free full text

View

Hormone therapy is the most effective treatment for managing menopausal vasomotor symptoms. Hot flashes and night sweats affect approximately 70% of midlife women and may persist for a decade or longer.1 Bothersome vasomotor symptoms have a significant adverse effect on sleep, daily functioning, and quality of life. Cognitive and mood symptoms often accompany disruptive hot flashes. Although lifestyle changes and nonhormonal options are available, women with frequent, severe vasomotor symptoms may greatly benefit from hormone therapy.2

Author/s:

Shifren, Jan L., Crandall, Carolyn J., Manson, JoAnn E.