Managing menopause: Current therapeutic options for vasomotor symptoms

PURPOSE: To describe and evaluate the available hormonal, nonhormonal pharmacologic, and dietary supplement preparations used for the treatment of menopausal vasomotor symptoms. EPIDEMIOLOGY: More than 75% of women experience hot flashes during perimenopause and more than 25% remain symptomatic for longer than 5 years. Vasomotor symptoms constitute the primary reason women seek medical care during this time. REVIEW SUMMARY: Menopause brings a unique set of issues, including hot flashes, depressed mood, and vaginal dryness. Of these, vasomotor symptoms are often the most debilitating for women and create a challenge for physicians. Coping mechanisms are a reasonable treatment choice for women with mild symptoms but are frequently inadequate to restore functionality to women with moderate to severe symptoms. Hormone therapy is the most effective management option for hot flashes. Other proven, albeit less efficacious, pharmacologic options do exist. These include serotonin reuptake inhibitors, gabapentin, and alpha2-adrenergic agents. Finally, "natural" alternatives have surged in popularity, as many women have turned to over-the-counter vitamins and herbal products. Scant short-term data exist for few of these popular dietary supplements. TYPE OF AVAILABLE EVIDENCE: Systematic reviews, randomized controlled trials, cohort studies, case-control series, nationally recognized treatment guidelines. GRADE OF AVAILABLE EVIDENCE: Poor to good. CONCLUSION: Many useful modalities exist for the treatment of menopausal vasomotor symptoms, with hormone therapy being the most effective. Future research should focus on the identification and evaluation of alternatives, including lower doses or different formulations of hormone therapy and other agents, with attention to long-term beneficial and adverse outcomes.