To update and expand The North American Menopause Society's evidence-based position on nonhormonal management of menopause-associated vasomotor symptoms (VMS), previously a portion of the position statement on the management of VMS.
METHODS: NAMS enlisted clinical and research experts in the field and a reference librarian to identify and review available evidence. Five different electronic search engines were used to cull relevant literature. Using the literature, experts created a document for final approval by the NAMS Board of Trustees.
RESULTS: Nonhormonal management of VMS is an important consideration when
hormone therapy is not an option, either because of
medical contraindications or a woman's personal choice. Nonhormonal
therapies include lifestyle changes, mind-body techniques, dietary management and supplements, prescription
therapies, and others. The costs, time, and effort involved as well as adverse effects, lack of long-term studies, and potential interactions with medications all need to be carefully weighed against potential effectiveness during decision making.
CONCLUSIONS: Clinicians need to be well informed about the level of evidence available for the wide array of nonhormonal management options currently available to midlife women to help prevent underuse of effective
therapies or use of inappropriate or ineffective
therapies. Recommended: Cognitive-behavioral therapy and, to a lesser extent,
clinical hypnosis have been shown to be effective in reducing VMS.
Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS, although other selective
serotonin reuptake/
norepinephrine reuptake inhibitors, gabapentinoids, and
clonidine show evidence of efficacy. Recommend with caution: Some
therapies that may be beneficial for alleviating VMS are
weight loss, mindfulness-based stress reduction, the S-
equol derivatives of soy
isoflavones, and stellate ganglion block, but additional studies of these
therapies are warranted. Do not recommend at this time: There are negative, insufficient, or inconclusive data suggesting the following should not be recommended as proven
therapies for managing VMS: cooling techniques, avoidance of triggers, exercise, yoga, paced respiration, relaxation, over-the-counter supplements and herbal
therapies, acupuncture, calibration of neural oscillations, and chiropractic interventions. Incorporating the available evidence into clinical practice will help ensure that women receive evidence-based recommendations along with appropriate cautions for appropriate and timely management of VMS.