Non-hormonal therapies for the treatment of menopausal symptoms

Hot flushes affect approximately 75% of postmenopausal women and are one of the most distressing symptoms that women experience as they enter the menopause.The treatment of hot flushes is a common clinical challenge. Hormone replacement therapy (HRT) effectively reduces vasomotor symptoms by 80-90%, however, many patients may be unable or unwilling to undergo hormonal treatment. Publication of the results of the Women’s Health Initiative (WHI) and the Million Women Study (MWS) has led to considerable uncertainties about the role of HRT among health professionals and women. The estrogen and progestin arm of the Women's Health Initiative and other recent reports suggest that HRT may increase the risk for coronary heart disease events, strokes, venous thromboembolism, and invasive breast cancer. Many expert groups recommend that combination hormonal therapy for the management of vasomotor symptoms should be limited to the shortest duration consistent with treatment goals and benefits versus risks for individual women. All of these concerns have generated interest in non-hormonal treatment of hot flushes. Such therapies, readily available for the menopausal patient could become a therapeutic nightmare -especially when taken without physician supervision. Data for these therapies are limited, and most of the studies have been conducted in women with a history of breast cancer. In this review we discuss the evidence underlying the commonly used nonhormonal therapies for hot flushes in terms of efficacy and safety.