WOMEN'S HEALTH
Complementary and Hormonal Therapy for Vasomotor Symptom Relief: A Conservative Clinical Approach

https://doi.org/10.1016/S1701-2163(16)32136-3Get rights and content

Abstract

Vasomotor symptoms are the most common menopausal symptom experienced by women and the leading reason menopausal women seek health care advice. The recent shift towards a more conservative use of hormone therapy (HT) during menopause has prompted the need for treatment regimens to be individualized according to symptom severity. Our objective was to develop a new algorithm that enables practitioners to customize treatment regimens according to symptom severity. In order to develop a comprehensive treatment algorithm, we conducted a literature review and considered the findings from recently published treatment guidelines from around the world. We also evaluated the results of systematic reviews investigating the efficacy and safety of complementary and alternative medicines. We found a growing trend away from prescription HT in women with mild to moderate symptoms and an increasing trend toward lifestyle modification and the use of complementary and alternative medicines.

On the basis of these findings, we have developed an algorithm that accounts for symptom severity. The algorithm presented here provides treatment options based on symptom severity and a comprehensive approach for integrating lifestyle modifications and complementary therapies with prescription treatment regimens.

Résumé

Les symptômes vasomoteurs sont les symptômes ménopausiques que les femmes connaissent le plus couramment et constituent la principale raison pour laquelle les femmes ménopausées cherchent à obtenir des conseilsde santé. La tendance récente vers une utilisation plus conservatrice de l'hormonothérapie (HT) au cours de la ménopause a souligné la nécessité de procéder à la personnalisation des schémas de traitement en fonction de la gravité des symptômes. Notre objectif était de mettre au point un nouvel algorithme permettant aux praticiens de personnaliser les schémas de traitement en fonction de la gravité des symptômes. Afin d'élaborer un algorithme de traitement exhaustif, nousavons mené une analyse documentaire et pris en considération les résultats issus de directives cliniques publiées récemment de par le monde. Nous avons également évalué les résultats d'analyses systématiques s'étant penchées sur l'efficacité et l'innocuité des approches de médecine parallèle. Nous avons constaté, chez les femmes connaissant des symptômes allant de légers à modérés, une tendance à délaisser les HT d'ordonnance en faveur de la modification du mode de vie etdu recours à la médecine parallèle.

En fonction de ces résultats, nous avons conçu un algorithme qui tient compte de la gravitédes symptômes. L'algorithme présenté ici offre des options de traitement fondées sur la gravité des symptômes, ainsi qu'une approche exhaustive quant à l'intégration des schémas de traitement d'ordonnance à la modification du mode de vieet au recours à la médecine parallèle.

REFERENCES (70)

  • G. Maskarinec et al.

    A 2-year soy intervention in premenopausal women does not change mammographic densities

    J Nutr

    (2004)
  • V. Unfer et al.

    Endometrial effects of long-term treatment with phytoestrogens: a randomized, double-blind, placebo-controlled study

    Fertil Steril

    (2004)
  • W. Wuttke et al.

    The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers

    Maturitas

    (2003)
  • NAMS Position Paper

    Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society

    Menopause

    (2004)
  • J.R. Guthrie et al.

    Health care-seeking for menopausal problems

    Climacteric

    (2003)
  • A.L. Hersh et al.

    National use of postmenopausal hormone therapy

    JAMA

    (2004)
  • Writing group for the Women’s Health Initiative Investigators

    Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women’s Health Initiative randomized controlled tria

    JAMA

    (2002)
  • D. Grady et al.

    Cardiovascular disease outcomes during 6.8 years of hormone therapy

    JAMA

    (2002)
  • International Menopause Society

    Guidelines for hormone treatment of women in the menopausal transition and beyond. Position Statement by the Executive Committee of the International Menopause Society

    Climacteric

    (2004)
  • I. Bilgrami et al.

    Changes in the use of hormone replacement therapy in New Zealand following the publication of the Women’s Health Initiative trial

    NZ Med J

    (2004)
  • J.E. Blumel et al.

    Patients’ and clinicians’ attitudes after the Women’s Health Initiative study

    Menopause

    (2004)
  • International Menopause Society

    Practical recommendations for hormone replacement therapy in the peri- and postmenopause

    Climacteric

    (2004)
  • The SOGC statement on the WHI report on estrogen and progestin use in postmenopausal women

    J Obstet Gynaecol Can

    (2002)
  • Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Statement No C-Gyn 9, November...
  • American Association of Clinical Endocrinologists. Position WHI. Available at:...
  • Australasian Menopause Society HT consensus statement. 12th August 2004. Available at: http://www.menopause.org.au/....
  • Position Statement by the Executive Committee of the International Menopause Society. Guidelines for the hormone treatment of women in the menopausal transition and beyond

    Climacteric

    (2004)
  • Managing the menopause

    Consensus statement on hormone replacement therapy. June

    (2004)
  • P. Kaufert et al.

    Women and menopause: beliefs, attitudes, and behaviors. The North American Menopause Society 1997 Menopause Survey

    Menopause

    (1998)
  • S. Gollschewshi et al.

    The use of complementary and alternative medications by menopausal women in South East Queensland

    Women’s Health Issues

    (2004)
  • N.L. Keenan et al.

    Severity of menopausal symptoms and use of both conventional and complementary/alternative therapies

    Menopause

    (2003)
  • A. Vashisht et al.

    Prevalence of and satisfaction with complementary therapies and hormone replacement therapy in a specialist menopause clinic

    Climacteric

    (2001)
  • I.W. Kam et al.

    Dietary supplement use among menopausal women attending a San Francisco health conference

    Menopause

    (2002)
  • J.H. Irvin et al.

    The effects of relaxation response training on menopausal symptoms

    J Psychosom Obstet Gynaecol

    (1996)
  • V. Beck et al.

    Comparison of hormonal activity (estrogen, androgen and progestin) of standardized plant extract for large scale use in hormone replacement therapy

    J Steroid Biochem Mol Biol

    (1831)
  • Cited by (25)

    • Hormone Therapy for Menopausal Women in the Primary Care Setting

      2017, Journal for Nurse Practitioners
      Citation Excerpt :

      This leaves menopausal women susceptible to dyspareunia and atrophic vaginal mucosa and puts them at an increased risk for urinary tract infections.4,12 VMSs, particularly hot flashes, are the most common reasons that women seek care during the perimenopausal and menopausal period, along with urovaginal symptoms.3,8 The North American Menopause Society (NAMS) recommends lifestyle changes, such as regular exercise and regulation of body temperature through the layering of clothing and the use of external heating/cooling systems, as the initial step for the management of VMS, whereas suggestions for nonprescription options include the use of vitamin E, soy, and black cohosh.3,4,7

    • Managing hot flushes in menopausal women: A review

      2018, Journal of the College of Physicians and Surgeons Pakistan
    View all citing articles on Scopus

    Competing Interests: See Acknowledgements.

    View full text