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|Issue 117||October 2016|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Evidence Report: Non-Pharmacologic Treatments for Vasomotor Symptoms Associated with Menopause
Vasomotor symptoms (VMS), which include hot flashes and night sweats, are the most common symptoms reported during the menopausal transition. VMS symptoms are experienced by as many as 80% of women with a mean age of onset of 51 years, and can last more than seven years. VMS can lead to increased healthcare encounters for symptom relief and reductions in quality of life. The degree to which VMS are bothersome is determined not only by how frequently they occur, but also by other factors such as duration, coexisting sleep problems, and the extent to which VMS interferes with daily activities or job-related activities. For some populations of women, VMS exerts an especially strong, negative impact on quality of life, which appears to be the case for women Veterans. Based on the age (>45 years) of the current women Veterans population, half of the approximately 360,000 women Veterans who use VA healthcare are perimenopausal (around menopause) or postmenopausal.
Hormone therapy (HT) is an effective treatment for reducing VMS, but the use of HT must be individualized through weighing benefits with known risks, such as cardiovascular events or uterine and breast cancers. Despite this, recent evidence indicates that compared with the general population of women in the United States, women Veterans using VA healthcare are twice as likely to use hormone therapy for relief of menopausal symptoms. Due in part to concerns about possible harms from long-term hormone therapy and, in part, to uncertain efficacy and safety of pharmacologic treatments, many women with VMS seek non-hormonal, non-pharmacologic treatment options (i.e., herbal remedies, yoga, tai chi). Therefore, investigators with VA's Evidence-based Synthesis Program (ESP) located in Durham, NC, have summarized and updated the evidence from systematic reviews on selected non-pharmacologic approaches for the management of menopause-associated VMS and health-related quality of life. Investigators searched MEDLINE and the Cochrane Database of Systematic Reviews from January 2010 through November 2015, with additional searches for more recent (since 2012) randomized controlled trials (RCTs) through February 2016. From this search, 10 systematic reviews and 14 RCTs were eligible and analyzed in this ESP Evidence Report.
Summary of Report
There is insufficient evidence to draw conclusions about the effectiveness of these non-pharmacologic therapies for improving sleep, depression, or anxiety. The safety of the non-pharmacologic, non-hormonal approaches evaluated in this report has not been rigorously examined, but there is no clear signal for a significant potential for harm. Overall, most of the data included in this report comes from smaller studies with homogenous participant populations. Larger trials of populations more reflective of the diversity of women experiencing VMS will be necessary to discern the effectiveness of non-pharmacologic interventions in symptomatic menopausal women. Following are some specific findings.
Yoga, Tai Chi, and Qigong
Meditation, Mindfulness, Hypnosis, and Relaxation
Further, none of the RCTs included in this review specifically involved Veterans. Additional research is needed to evaluate the acceptability, feasibility, and comparative effectiveness of non-pharmacologic approaches to managing menopausal symptoms for women Veterans in VA primary care clinics, as well as other settings and patient populations such as medically underserved populations.
A cyberseminar session titled "Nonpharmacologic Treatments for Menopause-associated Vasomotor Symptoms" will be held on December 19, 2016 from 1:00pm to 2:00pm (ET). To register, go to the HSR&D Cyberseminar web page.
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ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers – and to disseminate these reports throughout VA.
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