Nonhormonal Management Of Menopause-Associated Vasomotor Symptoms

Publication Date: June 1, 2023
Last Updated: June 5, 2023

Summary of Key Points

LIFESTYLE

  • There is no strong evidence that lifestyle changes such as cooling techniques and avoiding triggers improve VMS.
  • There is insufficient or poor evidence to consider exercise or yoga as a treatment for VMS.
  • A healthy diet is important for health promotion and chronic disease prevention; however, there is limited evidence to support dietary modifications as a tool for improving VMS.
  • Weight loss may be considered for improving VMS.

MIND-BODY TECHNIQUES

  • CBT has been shown to reduce the bother and interference associated with VMS.
  • Clinical hypnosis has been shown to reduce VMS frequency and severity.
  • MBSR interventions for themanagement ofVMS are limited by sample size and lack of control groups and are not designed to considerVMS; therefore, there are not enough data to recommend treatment.
  • Paced breathing and relaxation techniques do not alleviate VMS and are not recommended.

PRESCRIPTION THERAPIES

  • SSRIs and SNRIs are associated with mild to moderate improvements in VMS.
  • Gabapentin is associated with improvements in the frequency and severity of VMS.
  • Pregabalin is not recommended forVMS because ofAEs and controlled-substance prescribing restrictions.
  • Because of significant AEs and no recent studies showing greater benefit than placebo, clonidine is not recommended.
  • Oxybutynin has been shown to reduce moderate to severe VMS, although in older adults, long-term use may be associated with cognitive decline.
  • Given limited data, suvorexant is not recommended.
  • Fezolinetant is a first-in-class neurokinin B antagonist that is FDA approved for management of vasomotor symptoms.

DIETARY SUPPLEMENTS

  • Given mixed evidence of benefit forVMS, soy foods, soy extracts, and the soy metabolite equol are not recommended.
  • Given the lack of rigorous, evidence-based scientific research supporting the use of any over-the-counter supplements and herbal therapies for the management of VMS, these remedies are not recommended.
  • Cannabinoids are not recommended for the treatment of VMS.

ACUPUNCTURE, OTHER TREATMENTS, AND TECHNOLOGIES

  • Existing evidence does not support the use of traditional acupuncture for the treatment of VMS; electroacupuncture requires more rigorous study before it can be recommended.
  • Stellate ganglion blockade might alleviate moderate to very severe VMS in select women but is associated with potential risk.
  • Calibration of neural oscillations and chiropractic interventions are not recommended for treatment of VMS.

RECOMMENDATIONS

  • Vasomotor symptoms are common in midlife women and remain undertreated.
  • These symptoms can disrupt a women’s overall quality of life and last a mean duration of 7 to 9 years, longer in some women.
  • Hormone therapy remains the first-line recommended treatment to ameliorate VMS in healthy women at or around the time of menopause.
  • However, it is important to recognize that not all women are candidates for HT because of contraindications or personal preference.
  • This Position Statement supports the use of and recommends CBT, clinical hypnosis, SSRIs, SNRIs, gabapentin, fezolinetant (Level I); oxybutynin (Levels I-II); weight loss, stellate ganglion block (Levels IIIII).
  • There is negative or insufficient evidence for these, so they are not recommended: paced respiration (Level I); supplements/herbal remedies (Levels I-II); cooling techniques, avoiding triggers, exercise, yoga, MBI, relaxation, suvorexant, soy foods and soy extracts, soy metabolite equol, cannabinoids, acupuncture, calibration of neural oscillations (Level II), chiropractic interventions, clonidine; (Levels I-III); dietary modification and pregabalin (Level III).
  • Clinicians should be knowledgeable of the nonhormone options supported by evidence that are available to offer to women.

Recommendation Grading

Overview

Title

Nonhormonal Management Of Menopause-Associated Vasomotor Symptoms

Authoring Organization

North American Menopause Society

Publication Month/Year

June 1, 2023

Last Updated Month/Year

May 1, 2024

Supplemental Implementation Tools

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Document Objectives

Evidence-based review of the literature resulted in several nonhormone options for the treatment of vasomotor symptoms. Recommended: Cognitive-behavioral therapy, clinical hypnosis, selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors, gabapentin, fezolinetant (Level I); oxybutynin (Levels I-II); weight loss, stellate ganglion block (Levels II-III). Not recommended: Paced respiration (Level I); supplements/herbal remedies (Levels I-II); cooling techniques, avoiding triggers, exercise, yoga, mindfulness-based intervention, relaxation, suvorexant, soy foods and soy extracts, soy metabolite equol, cannabinoids, acupuncture, calibration of neural oscillations (Level II); chiropractic interventions, clonidine; (Levels I-III); dietary modification and pregabalin (Level III).

Inclusion Criteria

Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Assessment and screening, Treatment, Management

Diseases/Conditions (MeSH)

D008593 - Menopause, D014666 - Vasomotor System

Keywords

menopause, Complementary therapies, Hot flashes/diet therapy, Hot flashes/drug therapy, Hot flashes/ prevention and control, Post-menopause

Source Citation

The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023 Jun 1;30(6):573-590. doi: 10.1097/GME.0000000000002200. PMID: 37252752.