Searching for effective, nonhormonal treatments for vasomotor symptoms: is there a needle in the haystack?

EDITORIAL Searching for effective, nonhormonal treatments for vasomotor symptoms: is there a needle in the haystack? H ot flashes and night sweatsValso known as vaso-motor symptoms (VMS)Vare considered the hallmark of the menopausal transition. The prevalence rate of these symptoms has been reported to be between 60% and 85% in women during this period, although 10% to 20% of women may remained bothered by VMS in their late postmenopausal years. Vasomotor complaints of moderate to severe intensity have been shown to exert a negative impact on quality of life and overall functioning and linked to disrupted sleep, fatigue, lethargy, inability to concentrate, increased tension/irritability, anxiety, and depressive symptoms. 1 Therefore, the benefits of a safe, efficacious, and well-tolerated therapy for menopause-related VMS could extend beyond the immediate symptomatic relief. For decades, estrogen-based, menopausal hormone therapies (MHT) have been the treatment of choice to alleviate VMS in perimenopausal and postmenopausal women, with their supporters highlighting the broader scope of positive effects of MHT use on sexual function, bone density, cardiovascular protection, and even mood and cognition. MHT still remains a viable option for the management of VMS, but in reality, its acceptability has declined considerably during the past few years, given the wide publicity of the results from the Women's Health Initiative (WHI). Although some physicians expressed their skepticism about the WHI findings, they had a significant, adverse impact on many physicians' and patients' perception of the long-term safety and benefits of MHT. Consequently, many health professionals and their patients became more cautious or reluctant to initiate hormone therapies or to stay on MHT for longer periods of time; others started seeking nonhormonal strategies to improve menopause-related physical and psychological discomforts. Among nonhormonal strategies for VMS, some psycho-tropic medications have demonstrated efficacy in random-ized, controlled trials, but these agents face similar challenges with respect to patients' acceptability because of the potential stigma associated with their use and risks of unwanted adverse events such as weight gain and sexual dysfunction. Thus, the search for nonhormonal, nonprescription treatments for VMSVat least among most Western-based societiesV continues to be primarily focused on botanical agents and soy products. The overall impression, however, is that these agents have shown limited benefits when properly compared with placebo and are not risk-free in terms of adverse events. The use of acupuncture for the treatment of menopause-related VMS is not a novel concept; this therapy has been the focus …