title: Pooled Analysis of Six Pharmacologic and Nonpharmacologic Interventions for Vasomotor Symptoms.
abstract: OBJECTIVE
  To describe the effects of six interventions for menopausal vasomotor symptoms relative to control in a pooled analysis, facilitating translation of the results for clinicians and symptomatic women. The Menopause Strategies: Finding Lasting Answers for Symptoms and Health network tested these interventions in three randomized clinical trials.
  
  
  METHODS
  An analysis of pooled individual-level data from three randomized clinical trials is presented. Participants were 899 perimenopausal and postmenopausal women with at least 14 bothersome vasomotor symptoms per week. Interventions included 10-20 mg escitalopram per day, nonaerobic yoga, aerobic exercise, 1.8 g per day omega-3 fatty acid supplementation, 0.5 mg low-dose oral 17-beta-estradiol (E2) per day, and 75 mg low-dose venlafaxine XR per day. The main outcome measures were changes from baseline in mean daily vasomotor symptom frequency and bother during 8-12 weeks of treatment. Linear regression models estimated differences in outcomes between each intervention and corresponding control group adjusted for baseline characteristics. Models included trial-specific intercepts, effects of the baseline outcome measure, and time.
  
  
  RESULTS
  The 8-week reduction in vasomotor symptom frequency from baseline relative to placebo was similar for escitalopram at -1.4 per day (95% confidence interval [CI] -2.7 to -0.2), low-dose E2 at -2.4 (95% CI -3.4 to -1.3), and venlafaxine at -1.8 (95% CI -2.8 to -0.8); vasomotor symptom bother reduction was minimal and did not vary across these three pharmacologic interventions (mean -0.2 to -0.3 relative to placebo). No effects on vasomotor symptom frequency or bother were seen with aerobic exercise, yoga, or omega-3 supplements.
  
  
  CONCLUSIONS
  These analyses suggest that escitalopram, low-dose E2, and venlafaxine provide comparable, modest reductions in vasomotor symptom frequency and bother among women with moderate hot flushes.
  
  
  BACKGROUND
  ClinicalTrials.gov, www.clinicaltrials.gov, NCT00894543 (MsFLASH 01), NCT01178892 (MsFLASH 02), and NCT01418209 (MsFLASH 03).
authors.affiliation: MsFLASH Data Coordinating Center, Fred Hutchinson Cancer Research Center, the Group Health Research Institute, and the University of Washington School of Medicine, Seattle, Washington; the Department of Family and Preventive Medicine, University of California, San Diego, San Diego, and the Division of Research, Kaiser Permanente, Oakland, California; the VA Medical Center/University of Minnesota, Minneapolis, Minnesota; Brigham and Women's Hospital, Dana Farber Cancer Institute, and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; the School of Nursing and the Department of Medicine, Division of Clinical Pharmacology, Indiana University, Indianapolis, Indiana; and the Departments of Obstetrics and Gynecology and Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Guthrie
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.forename: Hadine
authors.initials: H
authors.lastname: Joffe
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Newton
authors.forename: Susan D
authors.initials: SD
authors.lastname: Reed
authors.forename: Bette
authors.initials: B
authors.lastname: Caan
authors.forename: Janet S
authors.initials: JS
authors.lastname: Carpenter
authors.forename: Lee S
authors.initials: LS
authors.lastname: Cohen
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Freeman
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Larson
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.forename: Kathy
authors.initials: K
authors.lastname: Rexrode
authors.forename: Todd C
authors.initials: TC
authors.lastname: Skaar
authors.forename: Barbara
authors.initials: B
authors.lastname: Sternfeld
authors.forename: Garnet L
authors.initials: GL
authors.lastname: Anderson
mesh_terms: D015283:Citalopram / Q000008:administration & dosage / Q000009:adverse effects; D003511:Cyclohexanols / Q000008:administration & dosage / Q000009:adverse effects; D019587:Dietary Supplements; D004311:Double-Blind Method; D004958:Estradiol / Q000008:administration & dosage / Q000009:adverse effects; D004967:Estrogens / Q000008:administration & dosage / Q000009:adverse effects; D015444:Exercise; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D019584:Hot Flashes / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D017063:Outcome Assessment, Health Care; D047648:Perimenopause / Q000187:drug effects; D017698:Postmenopause / Q000187:drug effects; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D014666:Vasomotor System / Q000187:drug effects / Q000503:physiopathology; D000069470:Venlafaxine Hydrochloride; D015013:Yoga
chemical_list: D015283:Citalopram; D003511:Cyclohexanols; D004958:Estradiol; D004967:Estrogens; D015525:Fatty Acids, Omega-3; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride