Treating vasomotor symptoms of menopause: the nurse practitioner's perspective.
OBJECTIVE
This article reviews the pathophysiology of vasomotor symptoms (VMS) of menopause and current management options.


METHODS
Current scientific literature.


CONCLUSIONS
In most menopausal women, loss of ovarian function results in VMS, including hot flashes, night sweats, and mood and sleep disturbances. Hormone therapy (HT) has been the mainstay of VMS treatment for many years, but safety concerns raised by publication of the Women's Health Initiative (WHI) results have dramatically reduced the use of this treatment. Since the WHI published its findings, attention has focused on other novel treatments for menopausal symptoms, including low-dose oral or transdermal HT and agents such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, gabapentin, and clonidine. Many women also use complementary and alternative medications to manage VMS, but little evidence from controlled clinical trials supports their efficacy.


CONCLUSIONS
The increasing number of alternative treatments for VMS requires improvement in patient-provider communication about treatment risks and benefits, individualization of treatment to meet patient needs and attitudes, and careful follow-up to ensure adherence to potentially effective therapy. Nurse practitioners play a leading role in patient evaluation, discussions, and management to help women achieve control over bothersome VMS that dramatically impact their quality of life.
Alexander
Ivy M
IM
Yale University School of Nursing, New Haven, Connecticut 06536-0740, USA. ivy.alexander@yale.edu
Moore
Anne
A
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000465:Algorithms; D000588:Amines / Q000627:therapeutic use; D015283:Citalopram / Q000627:therapeutic use; D003000:Clonidine / Q000627:therapeutic use; D000529:Complementary Therapies; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000379:methods / Q000451:nursing; D019317:Evidence-Based Medicine; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D000077206:Gabapentin; D019584:Hot Flashes / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008019:Life Style; D008593:Menopause / Q000187:drug effects / Q000502:physiology* / Q000523:psychology; D008875:Middle Aged; D009722:Nurse Practitioners / Q000458:organization & administration*; D017374:Paroxetine / Q000627:therapeutic use; D010353:Patient Education as Topic; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration; D017751:Safety Management; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000316:Adrenergic alpha-Agonists; D000588:Amines; D015283:Citalopram; D003000:Clonidine; D003509:Cyclohexanecarboxylic Acids; D005473:Fluoxetine; D000077206:Gabapentin; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D005680:gamma-Aminobutyric Acid