title: Assessing risks and benefits of nonhormonal treatments for vasomotor symptoms in perimenopausal and postmenopausal women.
abstract: BACKGROUND
  Vasomotor symptoms (VMS); (hot flushes and night sweats) are the most common menopausal complaint for which women seek treatment. Several therapies can be considered to help manage these complaints. The objective of this review is to assess the risks and benefits of available and emerging therapeutic options for the management of menopausal VMS.
  
  
  METHODS
  A review of the literature was conducted based on relevant publications identified through a PubMed search for clinical trials of agents used in the treatment of VMS.
  
  
  RESULTS
  Hormone therapy (HT) remains the most effective treatment available, but there will always remain a need for nonhormonal options. Evidence does not support the efficacy of alternative or over-the-counter products, such as phytoestrogens and black cohosh, and their long-term safety is largely unknown. There is evidence supporting the efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the management of VMS from clinical trials of paroxetine, venlafaxine, and desvenlafaxine. Gabapentin appears to be effective, but the doses required may cause poor tolerability and reduced patient adherence. Data also suggest that clonidine has a modest effect at the expense of considerable adverse effects.
  
  
  CONCLUSIONS
  Choosing an appropriate treatment approach for the management of VMS requires careful assessment of the riskbenefit ratio of each alternative, as well as individual patient preference.
authors.affiliation: Center for Specialized Women's Health, Cleveland Clinic, Cleveland, OH 44195, USA. thackeh@ccf.org
authors.forename: Holly L
authors.initials: HL
authors.lastname: Thacker
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D019584:Hot Flashes / Q000628:therapy*; D006801:Humans; D008019:Life Style; D008593:Menopause / Q000187:drug effects*; D008875:Middle Aged; D047648:Perimenopause / Q000187:drug effects*; D008517:Phytotherapy / Q000379:methods; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D014652:Vascular Diseases / Q000628:therapy*; D014666:Vasomotor System / Q000503:physiopathology*; D016387:Women's Health
chemical_list: D000316:Adrenergic alpha-Agonists; D003509:Cyclohexanecarboxylic Acids; D017367:Selective Serotonin Reuptake Inhibitors