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Non-Hormonal Treatment Strategies for Vasomotor Symptoms

A Critical Review

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Abstract

Hot flashes (or flushes) are the most commonly reported symptoms during the menopause transition and early postmenopausal years, particularly in Western societies; they affect 60–90% of women and can lead to significant physical discomfort and functional impairment. The emergence of hot flashes and night sweats (also known as vasomotor symptoms [VMS]) coincide with a period in life that is also marked by dynamic changes in hormone and reproductive function that interconnect with the aging process, changes in metabolism, lifestyle behaviours and overall health.

Estrogen-based therapies have long been the treatment of choice for women suffering from VMS. More recent concerns over long-term safety of menopausal hormone treatments, however, have led physicians and patients to pursue non-hormonal strategies to alleviate their symptoms.

In this article, we review most of the efficacy and safety data on non-hormonal treatments for VMS published over the past 20 years. We discuss the evidence for treating symptomatic women in different clinical scenarios, e.g. VMS with and without concomitant depression or VMS following the use of anti-estrogen therapies. Overall, efficacy data support the use of some psychotropic medications, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors and gabapentin. Complementary and alternative methods for VMS also showed limited but promising results, although more definitive studies are warranted. Clinicians should therefore be abl to tailor treatment strategies for those who are unable or unwilling to use hormones to alleviate VMS and improve overall functioning and quality of life.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. Dr Hall has no conflicts of interest that are directly relevant to the content of this review. Dr Frey has received research grants/grant support from the Canadian Institutes of Health Research (CIHR), Stanley Medical Research Institute, Father Sean O’Sullivan Research Centre, Bristol-Myers Squibb, Wyeth and Eli Lily. He has served on the advisory boards or speakers bureau of AstraZeneca and Wyeth. Dr Soares has received research grants from Wyeth, Pfizer, AstraZeneca and Eli Lily, as well as from the CIHR, NARSAD Foundation, AllerGen NCE and Hamilton Community Foundation. He has served as a consultant and/or speaker for AstraZeneca, Pfizer, Lundbeck, Wyeth and Eli Lily.

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  1. Department of Psychiatry and Behavioural Neurosciences & Department of Obstetrics and Gynecology, Academic Head, Mood Disorders Division & Women’s Health Concerns Clinic, McMaster University, 301 James St South FB638, Hamilton, Ontario, L8P 3B6, Canada

    Elise Hall, Benicio N. Frey & Claudio N. Soares (Associate Professo)

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  1. Elise Hall
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Correspondence to Claudio N. Soares.

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Hall, E., Frey, B.N. & Soares, C.N. Non-Hormonal Treatment Strategies for Vasomotor Symptoms. Drugs 71, 287–304 (2011). https://doi.org/10.2165/11585360-000000000-00000

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