Treatment strategies for reducing the burden of menopause-associated vasomotor symptoms.

BACKGROUND Vasomotor symptoms (VMS), such as hot flashes and night sweats, are the most bothersome symptoms of menopause and affect an estimated 75% of women aged over 50 years. OBJECTIVE To discuss the burden, pathophysiology, and management of menopause-associated VMS and to evaluate pharmacologic options available for the treatment of VMS, including herbal remedies, hormone replacement therapy (HRT), and nonhormonal therapies. SUMMARY Lifestyle changes, including regulation of core body temperature, relaxation techniques, regular physical activity, weight loss, and smoking cessation may help reduce the risk of VMS and should be implemented by all women with menopause-associated VMS. The role of herbal remedies in the treatment of VMS remains unclear, as clinical trial efficacy data are inconsistent and inconclusive. Nevertheless, soy isoflavones, red clover isoflavones, black cohosh, and vitamin E are commonly used to treat VMS and may be considered in women with mild symptoms that are not controlled by lifestyle changes alone. These herbal remedies appear to be safe when used for short durations (d 6 months). HRT, consisting of estrogen (in women without a uterus) or estrogen plus progestin (in women with a uterus) is the most widely studied and most effective treatment option for relief of menopause-associated VMS and is considered the standard of care for women with moderate-to-severe VMS. HRT should be used at the lowest effective dose and for the shortest duration possible (preferably d 5 years) in women in whom the potential benefits outweigh the potential risks. Nonhormonal therapies, such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, gabapentin, and clonidine, may be appropriate alternatives in women who cannot or will not use HRT for VMS relief, such as those with a history of or at risk for breast cancer. CONCLUSION The physical and financial burden imposed by menopauseassociated VMS is immense. Optimum management of VMS includes lifestyle changes in all women and HRT in women with moderate-tosevere symptoms. Less effective herbal remedies or nonhormonal therapies may be appropriate in certain women, such as those with mild symptoms or those who cannot or will not take HRT.