• Alternative treatment of vasomotor symptoms with the demise of reproductive and ovarian function within evidence-based medicine
en To content

Alternative treatment of vasomotor symptoms with the demise of reproductive and ovarian function within evidence-based medicine

HEALTH OF WOMAN. 2016.10(116):37–41

Alternative treatment of vasomotor symptoms with the demise of reproductive and ovarian function within evidence-based medicine

Veropotvelyan P. N., Tsehmistrenko I. S., Veropotvelyan N. P., Guzhevskaya I. V.
«Interregional centre of medical genetics and prenatal diagnosis», Krivoy Rog
National medical University named after O. O. Bogomolets, Kyiv
Perinatal center, Kiev

The article рresents literature data nontraditional methods of treatment in recent years, for 5 years. And also the review highlights the consensus experts on this issue 2015–2016, results of efficacy and safety of non-pharmacological treatments, botanicals and neuroactive drugs for the treatment of vasomotor symptoms.

The evaluation of various treatment methods. Special attention is given to menopausal hormone therapy. The practical doctor should be informed about the level of evidence of efficacy and safety of complementary therapies to prevent, the insufficient use of effective and, conversely, the use of ineffective or unacceptable to patients. So the practical physician is obliged in each case to an individual, differentiated choice of treatment acceptable to the patient.

Key words: menopausal symptoms, various non-traditional methods of treatment, phytoestrogens, selective inhibitors of serotonin reuptake.


1. Boardman HM, Hartley L, Eisinga A, Main C, Roquй M i Figuls, Bonfill Cosp X et al. 2015. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst. Rev. (3):CD002229. https://doi.org/10.1002/14651858.cd002229.pub4

2. Rossouw JE, Manson JE, Kaunitz AM, Anderson GL. 2013. Lessons learned from the Women’s Health Initiative trials of menopausal hormone therapy. Obstet. Gynecol. 121(1):172–6. https://doi.org/10.1097/AOG.0b013e31827a08c8; PMid:23262943 PMCid:PMC3547645

3. Boekhout AH, Vincent AD, Dalesio OB, van den Bosch J, Foekema-Tons JH, Adriaansz S et al. 2011. Management of hot flashes in patients who have breast cancer with venlafaxine and clonidine: a randomized, double-blind, placebo-controlled trial. J. Clin. Oncol. 29(29):3862–8. https://doi.org/10.1200/jco.2010.33.1298

4. Peng W, Adams J, Sibbritt DW, Frawley JE. 2014. Critical review of complementary and alternative medicine use in menopause: focus on prevalence, motivation, decision-making, and communication. Menopause 21(5):536–48. https://doi.org/10.1097/GME.0b013e3182a46a3e; PMid:24104604

5. Gentry-Maharaj A, Karpinskyj C, Glazer C, Burnell M, Ryan A, Fraser L et al. 2015. Use and perceived efficacy of complementary and alternative medicines after discontinuation of hormone therapy: a nested United Kingdom Collaborative Trial of Ovarian Cancer Screening cohort study. Menopause 22(4):384–90. https://doi.org/10.1097/GME.0000000000000330; PMid:25290539 PMCid:PMC4470524

6. Schierbeck LL, Rejnmark L, Tofteng CL, Stilgren L, Eiken P, Mosekilde L et al. 2012. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomized trial. BMJ. 345:e6409. https://doi.org/10.1136/bmj.e6409; PMid:23048011

7. Lobo RA. 2015. The hope for KEEPS. Climacteric. 18(2):108–9. https://doi.org/10.3109/13697137.2015.1007428; PMid:25651981

8. Hodis HN, Mack WJ, Henderson VW, Shoupe D, Budoff MJ, Hwang-Levine L et al. 2016. Vascular effects of early versus late postmenopausal treatment with estradiol. N. Engl. J. Med. 374(13):1221–31. https://doi.org/10.1056/NEJMoa1505241; PMid:27028912 PMCid:PMC4921205

9. Haney EM, Warden SJ, Bliziotes MM. 2010. Effects of selective serotonin reuptake inhibitors on bone health in adults: time for recommendations about screening, prevention and management? Bone. 46(1):13–7. https://doi.org/10.1016/j.bone.2009.07.083; PMid:19664737 PMCid:PMC3413453

10. Hayes LP, Carroll DG, Kelley KW. 2011. Use of gabapentin for the management of natural or surgical menopausal hot flashes. Ann. Pharmacother. 45(3):388–94. https://doi.org/10.1345/aph.1P366; PMid:21343402

11. Yureneva SV, Ilyinа LM, Ebzeeva ZH. 2016. Alternative treatments of vasomotor symptoms in light of evidence-based medicine. Obstetrics and gynecology 6:32–38.

12. Toulis КA, Tzellos T, Kouvelas D, Goulis DG. 2009. Gabapentin for the treatment of hot flashes in women with natural or tamoxifen-induced menopause: a systematic review and meta-analysis. Clin. Ther. 31(2):221–35.

13. Smetnik V, Tumilovich L. 2005. «Non-operative gynecology». Moscow:99.

14. Blumel JE, Cruz MN, Aparicio NJ. 2002. Menopausal transition, physiopathology, clinical and treatment. Medicina 62(l):57–65.

15. Avis NE, Crawford SL, Greendale G, Bromberger JT, Everson-Rose SA, Gold EB et al. 2015. The Study of Women’s Health Across the Nation (SWAN). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern. Med. 175(4):531–9.

16. Zeleke BM, Bell RJ, Billah B, Davis SR. 2016. Vasomotor and sexual symptoms in older Australian women: a cross-sectional study. Fertil. Steril. 105(1):149–55. https://doi.org/10.1016/j.fertnstert.2015.09.017

17. Stuenkel CA, Davis SR, Gompel A, Lumsden MA, Murad MH, Pinkerton JV, Santen RJ. 2015. Treatment of symptoms of the menopause: An Endocrine Society Clinical Practice Guideline. Clin. Endocrinol. Metab. 100(11):3975–4011.

18. Smetnik VP. 2015. Menopausal hormone therapy and health preservation of women of Mature age. Clinical recommendations (treatment protocols). M.

19. Baber RJ, Panay N, Fenton A. 2016. The IMS Writing Group. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric. 19(2):109–50. https://doi.org/10.3109/13697137.2015.1129166; PMid:26872610

20. Maclennan AH, Broadbent JL, Lester S, Moore V. 2004. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst. Rev. (4):CD002978.

21. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML et al. 2002. Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA. 288(3):321–33.

22. Studd J. 2011. «PROFOX» – the post HRT nightmare. Climacteric. 14(2):217–9. https://doi.org/10.3109/13697137.2010.529199; PMid:21105839

23. Mintziori G, Lambrinoudaki I, Goulis DG, Ceausu I, Depypere H, Erel CT et al. 2015. EMAS position statement: non-hormonal management of menopausal vasomotor symptoms. Maturitas. 81(3):410–3. https://doi.org/10.1016/j.maturitas.2015.04.009; PMid:25982505

24. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause. 2015. 22(11):1155–74.

25. Daley A, Stokes-Lampard H, Thomas A, MacArthur C. 2014. Exercise for vasomotor menopausal symptoms. Cochrane Database Syst. Rev. (11):CD006108.

26. Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. 2013. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst. Rev. (12):CD001395.

27. Li L, Lv Y, Xu L, Zheng Q. 2015. Quantitative efficacy of soy isoflavones on menopausal hot flashes. Br. J. Clin. Pharmacol. 79(4):593–604.

28. Taku K, Melby MK, Kronenberg F, Kurzer MS, Messina M. 2012. Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: systematic review and meta-analysis of randomized controlled trials. Menopause 19(7):776–90. https://doi.org/10.1097/gme.0b013e3182410159; PMid:22433977

29. Schmidt M, Arjomand-Wolkart K, Birkhauser MH, Genazzani AR, Gruber DM, Huber J et al. 2016. Consensus: soy isoflavones as a first-line approach to the treatment of menopausal vasomotor complaints. Gynecol. Endocrinol. 32(6):427–30. https://doi.org/10.3109/09513590.2016.1152240

30. Setchell KD, Clerici C. 2010. Equol: history, chemistry, and formation. J. Nutr. 140(7):1355S-62S.

31. EFSA Panel on Food Additives and Nutrient Sources Added to Food (ANS). Risk assessment for peri- and postmenopausal women taking food supplements containing isolated isoflavones. EFSA J. 2015. 13(10):4246.

32. National Institute for Health and Clinical Excellence. NICE Clinical Guideline Menopause. 2015. Available at: https://www.nice.org.uk/guidance/ng23/resources/menopause-diagnosis-and- management-1837330217413.

33. Lipovac M, Chedraui P, Gruenhut C, Gocan A, Kurz C, Neuber B, Imhof M. 2012. The effect of red clover isoflavone supplementation over vasomotor and menopausal symptoms in postmenopausal women. Gynecol. Endocrinol. 28(3):203–7.

34. Edena JA. 2012. Phytoestrogens for menopausal symptoms: a review. Maturitas. 72(2):157–9. https://doi.org/10.1016/j.maturitas.2012.03.006; PMid:22516278

35. Leach MJ, Moore V. 2012. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst. Rev. (9):CD007244. PMid:22972105

36. Medicines and Healthcare products Regulatory Agency (MHRA). Liver failure case highlights need to use Black Cohosh remedies carefully. MHRA Press; 2012. Available at: press.office@mhra.psi.gov.uk

37. Fritz H, Seely D, McGowan J, Skidmore B, Fernandes R, Kennedy DA [et al.]. 2014. Black cohosh and breast cancer: a systematic review. Integr. Cancer Ther. 13(1):12–29. https://doi.org/10.1177/1534735413477191

38. Shechter M, Merz CN, Paul-Labrador M, Meisel SR, Rude RK, Molloy MD [et al.]. 1999. Oral magnesium supplementation inhibits platelet-dependent thrombosis in patients with coronary artery disease. Am. J. Cardiol. 84(2):152–6. https://doi.org/10.1016/S0002-9149(99)00225-8

39. Van Laecke S, Nagler EV, Vanholder R. 2012. Thrombotic microangiopathy: a role for magnesium? Thromb. Haemost. 107(3):399–408. https://doi.org/10.1160/TH11-08-0593; PMid:22274299

40. Nelson HD, Vesco KK, Haney E, Fu R, Nedrow A, Miller J et al. 2006. Nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis. JAMA 295(17):2057–71. https://doi.org/10.1001/jama.295.17.2057; PMid:16670414

41. Shams Т, Firwana B, Habib F, Alshahrani A, Alnouh B, Murad MN, Ferwana MJ. 2014. SSRIs for hot flashes: a systematic review and meta-analysis of randomized trials. Gen. Intern. Med. 29(1):204–13. https://doi.org/10.1007/s11606-013-2535-9

42. Rada G, Capurro D, Pantoja T, Corbalбn J, Moreno G, Letelier LM, Vera C. 2010. Non- hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst. Rev. (9):CD004923. https://doi.org/10.1002/14651858.cd004923.pub2

43. Fisher WI, Johnson AK, Elkins GR, Otte JL, Burns DS, Yu M, Carpenter JS. 2013. Risk factors, pathophysiology, and treatment of hot flashes in cancer. CA Cancer J. Clin. 63(3):167–92. https://doi.org/10.3322/caac.21171; PMid:23355109 PMCid:PMC3640615

44. Simon JA, Portman DJ, Kaunitz AM, Mekonnen H, Kazempour K, Bhaskar S, Lippman J. 2013. Low-dose paroxetine 7.5 mg for menopausal vasomotor symptoms: two randomized controlled trials. Menopause 20(10):1027–35. https://doi.org/10.1097/GME.0b013e3182a66aa7; PMid:24045678

45. Sun Z, Hao Y, Zhang M. 2013. Efficacy and safety of desvenlafaxine treatment for hot flashes associated with menopause: a meta-analysis of randomized controlled trials. Gynecol. Obstet. Invest. 75(4):255–62. https://doi.org/10.1159/000348564

46. Joffe H, Guthrie KA, LaCroix AZ, Reed SD, Ensrud KE, Manson JE et al. 2014. Low-dose estradiol and the serotonin-norepinephrine reuptake inhibitor venlafaxine for vasomotor symptoms: a randomized clinical trial. JAMA Intern. Med. 174(7):1058–66. https://doi.org/10.1001/jamainternmed.2014.1891

47. Steams V, Johnson MD, Rae JM, Morocho A, Novielli A, Bhargava P et al. 2003. Active tamoxifen metabolite plasma concentrations after coadministration of tamoxifen and the selective serotonin reuptake inhibitor paroxetine. J. Natl. Cancer Inst. 95(23):1758–64. https://doi.org/10.1093/jnci/djg108

48. Veropotvelyan PN, Tamamsheva AA, Radchenko VV, Veropotvelyan NP, Volenko NV. 2015. Klinicheskiy pohod k metabolicheskomu sindromu v menopauzalnom periode. Meditsinskie aspektyi zdorovya zhenschinyi 2(88):48–57.49. Gevorkyan MA, Manukhin IB et al. 2010. Modern approach to the treatment of women with pathological menopause. Medical Council 3(4):15–20.