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DRUG SELECTION PERSPECTIVES

Nonestrogen Treatment Modalities for Vasomotor Symptoms Associated with Menopause

Clinical Assistant Professor, Department of Pharmacy: Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK

Chelsea O Church, PharmD BCPS

Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, Southwestern Oklahoma State University; Pharmacy Education, St. Anthony Hospital, Oklahoma City

Reprints: Susan E Fugate PharmD BCPS CACP, Department of Pharmacy: Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, 1110 N. Stonewall, PO Box 26901, Oklahoma City, OK 73190-5040, fax 405/271-6430, Susan-Fugate{at}ouhsc.edu

OBJECTIVE: To systematically review the literature regarding the efficacy and safety of nonestrogen treatments for menopause-associated vasomotor symptoms not due to cancer or chemotherapy.

DATA SOURCES: Pertinent literature and clinical studies were identified by searching MEDLINE (1966–February 2004) and EMBASE (1959–February 2004) using the key search terms vasomotor symptoms, hot flashes, and menopause. Bibliographies of relevant articles were reviewed for additional references.

STUDY SELECTION AND DATA EXTRACTION: English-language articles reporting efficacy and safety of nonestrogen treatment modalities for perimenopausal and postmenopausal vasomotor symptoms were evaluated. All articles identified from the data sources were evaluated, and all information deemed relevant was included. Emphasis was placed on randomized, double-blind, placebo-controlled clinical trials, as these provide the best efficacy and safety data. Studies evaluating treatment of vasomotor symptoms from other causes, such as cancer or chemotherapy, were excluded.

DATA SYNTHESIS: Prescription medications reviewed for efficacy and safety in postmenopausal vasomotor symptoms include clonidine hydrochloride, danazol, gabapentin, methyldopa, mirtazapine, progestins, propranolol hydrochloride, selective serotonin-reuptake inhibitors (SSRIs), and venlafaxine. Nonprescription therapies reviewed include black cohosh, dong quai, evening primrose oil, physical activity, phytoestrogens, and red clover.

CONCLUSIONS: According to this systematic literature review, postmenopausal vasomotor treatments that have been shown to be safe and effective in short-term use include black cohosh, exercise, gabapentin, medroxyprogesterone acetate, SSRIs (ie, paroxetine hydrochloride), and soy protein. Initial, small reports are suggestive for efficacy in menopausal vasomotor symptoms with megestrol acetate and venlafaxine.

Key Words: menopause, nonestrogen, vasomotor symptoms

Published Online, August 3, 2004. www.theannals.com, DOI 10.1345/aph.1D610

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