title: Nonpharmacologic, nonherbal management of menopause-associated vasomotor symptoms: an umbrella systematic review (protocol).
abstract: BACKGROUND
  Vasomotor symptoms such as hot flashes and night sweats are a common concern of perimenopausal and postmenopausal women and are associated with a decreased quality of life. These symptoms can be effectively managed with hormone therapy, but safety concerns limit its use. Thus, understanding the effectiveness of nonpharmacologic therapies such as acupuncture or yoga is critical to managing these common symptoms in older women. Our review seeks to address the following question: In women with menopause-associated vasomotor symptoms, what are the effects on health-related quality of life, vasomotor symptoms, and adverse events of the following nonpharmacologic, nonherbal interventions as compared with any inactive control or active comparator: (a) acupuncture, (b) yoga, tai chi, and qigong, (c) structured exercise, and (d) meditation, mindfulness-based practices, and relaxation?
  
  
  METHODS
  We describe a protocol for an umbrella review approach, supplemented by evaluating randomized controlled trials (RCTs) published after the most recent good-quality systematic review for each of the eligible interventions. Specific interventions were chosen based on current literature and with input from a technical expert panel and organizational stakeholders. We will conduct a thorough literature search and perform a quality assessment of potentially included systematic reviews and RCTs.
  
  
  CONCLUSIONS
  Our umbrella review, supplemented by an additional search for eligible RCTs, aims to synthesize existing evidence on the use of nonpharmacologic, nonherbal interventions to manage bothersome vasomotor symptoms in perimenopausal and postmenopausal women.
  
  
  BACKGROUND
  PROSPERO CRD42016029335.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA. karen.goldstein@duke.edu.|Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, 411 W. Chapel Hill Street; Suite 500, Durham, NC, 27701, USA. karen.goldstein@duke.edu.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Goldstein
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.|Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, 411 W. Chapel Hill Street; Suite 500, Durham, NC, 27701, USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: McDuffie
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Shepherd-Banigan
authors.affiliation: Duke University School of Nursing, Durham, NC, USA.
authors.forename: Deanna
authors.initials: D
authors.lastname: Befus
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Remy R
authors.initials: RR
authors.lastname: Coeytaux
authors.affiliation: Duke University Medical Center Library, Durham, NC, USA.
authors.forename: Megan G
authors.initials: MG
authors.lastname: Van Noord
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.|Department of Physical Therapy, Duke University Medical Center, Durham, NC, USA.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Goode
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.
authors.forename: Varsha
authors.initials: V
authors.lastname: Masilamani
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Soheir
authors.initials: S
authors.lastname: Adam
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.
authors.forename: Avishek
authors.initials: A
authors.lastname: Nagi
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.|Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, 411 W. Chapel Hill Street; Suite 500, Durham, NC, 27701, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Williams
mesh_terms: D005260:Female; D019584:Hot Flashes / Q000628:therapy*; D006801:Humans; D008593:Menopause; D012107:Research Design; D013546:Sweating; D000078202:Systematic Reviews as Topic; D014666:Vasomotor System / Q000503:physiopathology
keywords: Menopause; Nonpharmacologic therapy; Umbrella review; Vasomotor symptoms