1. Nonhormonal Management of Menopause-associated Vasomotor Symptoms (VMS)
Key points from the
2015 Position Statement of The North American Menopause Society
North American Menopause Society. Menopause. 2015;22(11).
© 2015

2. Use of nonhormonal therapies is high
50% to 80% of North American women use nonhormonal therapies for VMS at midlife
North American Menopause Society. Menopause. 2015;22(11).
© 2015

3. Uncertainty about nonhormonal therapies
Most midlife women don’t feel fully informed or have concerns
75% don’t feel fully informed about herbals
64% have concerns or are unsure about herb-drug interactions
61% are not confident about herbal product dosing
North American Menopause Society. Menopause. 2015;22(11).
© 2015

4. Uncertainty leads to Use of inappropriate or ineffective therapies
Delay in use of effective therapies
Underuse of effective therapies
North American Menopause Society. Menopause. 2015;22(11).
© 2015

5. Recommend: NonRx
Two mind-body therapies have level I evidence showing positive effects
Cognitive behavioral therapy (CBT) protocols (MENOS 1 and MENOS 2)
Clinical hypnosis: Elkins protocol
North American Menopause Society. Menopause. 2015;22(11).
© 2015

6. MENOS 1 and MENOS 2
Protocols included psycho-education, paced breathing, CBT
Shown to reduce VMS problem ratings (but not frequency)
North American Menopause Society. Menopause. 2015;22(11).
© 2015

7. Elkins protocol
In-person hypnotherapy and at-home self-hypnosis practice
In postmenopausal women with >50 VMS/wk vs active therapy (structured attention) controls: significantly lower VMS frequency, scores
In breast cancer survivors vs no treatment: significantly reduced VMS, improved mood and sleep
North American Menopause Society. Menopause. 2015;22(11).
© 2015

8. Recommend: Prescription therapies
FDA-approved low-dose paroxetine salt
Other SSRIs and SNRIs yielding significant VMS reductions in large RCTs
Gabapentin and pregabalin
North American Menopause Society. Menopause. 2015;22(11).
© 2015

9. Other SSRIs, SNRIs Large RCTs show significant VMS reductions with
Paroxetine
Escitalopram
Citalopram
Venlafaxine
Desvenlafaxine
North American Menopause Society. Menopause. 2015;22(11).
© 2015

10. Prescription therapies: Choice
Depends on
Prior effective therapy
Patient history
Adverse events profile and tolerance of adverse effects
Coadministered medications
North American Menopause Society. Menopause. 2015;22(11).
© 2015

11. Prescription therapies: Choice (cont’d)
Depends on
Coexistence of mood disorder
VMS more bothersome day or night
Medication sensitivity
Pharmacogenetic testing
Patient preference
North American Menopause Society. Menopause. 2015;22(11).
© 2015

12. Prescription therapies: Considerations
Start lowest dose first; titrate up to effect, tolerance
When stopping, taper therapy over 1-2 wk
Re-evaluate carefully and regularly (eg, every 6-12 mo)
North American Menopause Society. Menopause. 2015;22(11).
© 2015

13. Recommend with caution
Level II evidence suggests these may be beneficial
Weight loss
Mindfulness-based stress reduction
S-equol derivative of soy
Stellate ganglion block
North American Menopause Society. Menopause. 2015;22(11).
© 2015

14. Do not recommend at this time
Over-the-counter supplements
Herbal therapies
Vitamins
Relaxation
Calibration of neural oscillations
Chiropractic intervention
North American Menopause Society. Menopause. 2015;22(11).
© 2015

15. Do not recommend at this time (cont’d)
These therapies appear risk free but have no evidence testing effects on VMS
Cooling techniques
Avoiding “triggers”
North American Menopause Society. Menopause. 2015;22(11).
© 2015

16. Do not recommend
Level I evidence shows these are unlikely to alleviate VMS, although they may have other health benefits
Exercise
Yoga
Paced respiration
Acupuncture
North American Menopause Society. Menopause. 2015;22(11).
© 2015