Nonestrogen treatment modalities for vasomotor symptoms associated with menopause.
OBJECTIVE
To systematically review the literature regarding the efficacy and safety of nonestrogen treatments for menopause-associated vasomotor symptoms not due to cancer or chemotherapy.


METHODS
Pertinent literature and clinical studies were identified by searching MEDLINE (1966-February 2004) and EMBASE (1959-February 2004) using the key search terms vasomotor symptoms, hot flashes, and menopause. Bibliographies of relevant articles were reviewed for additional references.


METHODS
English-language articles reporting efficacy and safety of nonestrogen treatment modalities for perimenopausal and postmenopausal vasomotor symptoms were evaluated. All articles identified from the data sources were evaluated, and all information deemed relevant was included. Emphasis was placed on randomized, double-blind, placebo-controlled clinical trials, as these provide the best efficacy and safety data. Studies evaluating treatment of vasomotor symptoms from other causes, such as cancer or chemotherapy, were excluded.


RESULTS
Prescription medications reviewed for efficacy and safety in postmenopausal vasomotor symptoms include clonidine hydrochloride, danazol, gabapentin, methyldopa, mirtazapine, progestins, propranolol hydrochloride, selective serotonin-reuptake inhibitors (SSRIs), and venlafaxine. Nonprescription therapies reviewed include black cohosh, dong quai, evening primrose oil, physical activity, phytoestrogens, and red clover.


CONCLUSIONS
According to this systematic literature review, postmenopausal vasomotor treatments that have been shown to be safe and effective in short-term use include black cohosh, exercise, gabapentin, medroxyprogesterone acetate, SSRIs (ie, paroxetine hydrochloride), and soy protein. Initial, small reports are suggestive for efficacy in menopausal vasomotor symptoms with megestrol acetate and venlafaxine.
Fugate
Susan E
SE
Department of Pharmacy, Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190-5040, USA. Susan-Fugate@ouhsc.edu
Church
Chelsea O
CO
D005081:Exercise Therapy; D005260:Female; D019584:Hot Flashes / Q000628:therapy*; D006801:Humans; D008593:Menopause / Q000187:drug effects* / Q000502:physiology; D004366:Nonprescription Drugs / Q000627:therapeutic use; D017698:Postmenopause / Q000187:drug effects; D016032:Randomized Controlled Trials as Topic; D014666:Vasomotor System / Q000187:drug effects*
D004366:Nonprescription Drugs