Contemporary Non-hormonal Therapies for the Management of Vasomotor Symptoms Associated with Menopause: A Literature Review

Introduction: Sleep disorders are one of the main complaints of women in transition from menopause, with a prevalence between 40% and 56%. However, regardless of the etiology, it is essential to assess the symptoms of insomnia in the context of menopause, as well as physical and mental health. Objective: To investigate the relationship between the transition from menopause to the causes of insomnia. Methodology: In April 2021, a literature review was carried out on MedLine using the descriptors “insomnia”, “menopause” and their respective synonyms, published in the last 5 years and available in full. Results: 157 articles were found, 4 of which were used in making this work. The precise mechanism of vasomotor symptoms is little known, but the hypothesis is that it results from a disturbance of the temperature regulating system in the hypothalamus, triggered by a decline in estrogen. Longitudinal data show that women with moderate to severe hot flashes are almost three times more likely to report frequent nighttime awakenings compared to women without hot flashes (HF). Conclusion: Therefore, HF is an important aspect of insomnia in the transition from menopause and is strongly associated with reports of interrupted sleep.

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Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors for menopausal vasomotor symptoms

Mental Health Clinician ◽

10.9740/mhc.2015.11.260 ◽

2015 ◽

Vol 5 (6) ◽

pp. 260-264

Author(s):

Kathryn M. Holt ◽

Amy N. Thompson

Keyword(s):

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Hormone Replacement ◽

Medical Intervention ◽

Serotonin Reuptake Inhibitors ◽

Selective Serotonin ◽

Vasomotor Symptoms ◽

Serious Adverse Events ◽

Hormonal Therapies ◽

Norepinephrine Reuptake

Abstract Introduction Some of the most bothersome symptoms associated with menopause are the vasomotor symptoms (VMS), characterized by transient elevations in body temperature associated with a narrowing of the thermoneutral zone and an abnormal firing rate of thermosensitive neurons in the hypothalamus. These VMS have traditionally been treated with hormone replacement therapy (HRT); however, after a trial suggesting an association between HRT and a number of serious adverse events, alternative therapies for VMS are being studied. The purpose of this review is to evaluate the available literature regarding the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) for the alleviation of VMS associated with menopause. Methods PubMed and Ovid/MEDLINE keyword searches were conducted. Literature was reviewed for inclusion if it included any SSRI or SNRI for menopausal symptoms published prior to August 31, 2014. Results Seven studies were included in this review article. No articles were found directly comparing HRT to either SSRIs or SNRIs. Multiple agents within these two classes have been studied for VMS in menopausal and postmenopausal women. Discussion Vasomotor symptoms related to the perimenopausal and postmenopausal period can lead to significant physical distress, often requiring medical intervention. Traditional therapies for VMS of menopause have been dominated by the use of HRT. There are conflicting data regarding the use of SSRIs and SNRIs for patients with vasomotor symptoms related to menopause, and these agents may not be ideal for all patients. These agents may be considered as an alternative in patients who have a contraindication or are concerned about using hormonal therapies.

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Menopause

Oxford Textbook of Obstetrics and Gynaecology ◽

10.1093/med/9780198766360.003.0046 ◽

2020 ◽

pp. 576-584

Author(s):

Jenifer Sassarini ◽

Mary Ann Lumsden

Keyword(s):

Vasomotor Symptoms ◽

Hot Flushes ◽

Primordial Follicles ◽

The United Kingdom ◽

Urogenital Atrophy ◽

Night Sweats ◽

Normal Ageing ◽

Long Term Consequences ◽

Hormonal Therapies

In the United Kingdom, menopause occurs in women at around the age of 51 years, and is part of the normal ageing process. It occurs as a result of a decrease in the number of primordial follicles after the age of 40 years, but can occur prematurely in 1% of women secondary to a number of aetiologies. This chapter covers the definition, and staging, of menopause and, using recently published guidance from the National Institute for Health and Care Excellence, gives recommendations on making a diagnosis. Hot flushes and night sweats (vasomotor symptoms) are the most commonly reported symptoms, but menopause may also be associated with urogenital atrophy, and long-term consequences include osteoporosis, cardiovascular disease, and dementia. Hormone therapy is effective in reducing flushing, but it is not suitable for all women and the evidence for its benefit and long-term consequences is controversial. Non-hormonal therapies are available, but best evidence must be considered when suggesting these alternatives.

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SAT-001 Clinically Meaningful Effects of E2/P4 Oral Capsule in Treating Vasomotor Symptoms

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.438 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Ginger Constantine ◽

Shelli Graham ◽

Dennis A Revicki ◽

Risa Kagan ◽

Sebastian Mirkin

Keyword(s):

Controlled Trial ◽

Clinical Importance ◽

Vasomotor Symptoms ◽

Life Questionnaire ◽

Double Blind ◽

Exact Test ◽

Menopausal Women ◽

Patient Reported ◽

Hormonal Therapies

Abstract Hormonal therapies effectively reduce the frequency and severity of vasomotor symptoms (VMS) in menopausal women; however, whether the effect is clinically meaningful to women is typically not determined. Oral estradiol/progesterone (E2/P4; mg/mg) 1/100 and 0.5/100 significantly improved moderate to severe VMS versus placebo at weeks 4 and 12. The objective of these analyses was to determine the clinical importance (meaningfulness) of E2/P4 treatment versus placebo in menopausal women. REPLENISH, a phase 3, randomized, double-blind, placebo-controlled trial, evaluated the safety and efficacy of E2/P4 oral capsules in symptomatic, postmenopausal women with a uterus. Clinically meaningful reductions in weekly VMS frequency were determined using 3 patient-reported outcomes as anchors (VMS severity score, clinical global impression [CGI], and question 1 from the vasomotor domain of the menopause-specific quality of life questionnaire). The proportion of women who had a clinically important response with 0.5/100 was compared with placebo using the Fisher’s exact test. Spearman correlations were also performed across the 3 anchors. Clinically meaningful reductions in weekly VMS frequency ranged from 32 to 43 at week 4, and from 32 to 48 at week 12. Significantly more responders were observed with 0.5/100 than with placebo for all 3 anchors at both weeks 4 (all, P<0.05) and 12 (all, P≤0.002). All 3 anchors were correlated, supporting their acceptability as appropriate anchors. Treatment with E2/P4 0.5/100 provided consistent clinically meaningful improvements in the weekly frequency of moderate to severe VMS in menopausal women, similar to what has been observed with the CGI-anchor for E2/P4 1/100.

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The Ultrastructure of Metastatic Human Mammary Carcinoma After Prolonged Estrogen Therapy

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010006091x ◽

1967 ◽

Vol 25 ◽

pp. 180-181

Author(s):

John H.L. Watson ◽

John L. Swedo ◽

R.W. Talley

Keyword(s):

Mammary Carcinoma ◽

Osmium Tetroxide ◽

Estrogen Therapy ◽

Ultrastructural Level ◽

Uranyl Acetate ◽

Human Mammary Carcinoma ◽

Surgical Biopsy ◽

Lead Hydroxide ◽

Preliminary Study ◽

Hormonal Therapies

A preliminary study of human mammary carcinoma on the ultrastructural level is reported for a metastatic, subcutaneous nodule, obtained as a surgical biopsy. The patient's tumor had responded favorably to a series of hormonal therapies, including androgens, estrogens, progestins, and corticoids for recurring nodules over eight years. The pertinent nodule was removed from the region of the gluteal maximus, two weeks following stilbestrol therapy. It was about 1.5 cms in diameter, and was located within the dermis. Pieces from it were fixed immediately in cold fixatives: phosphate buffered osmium tetroxide, glutaraldehyde, and paraformaldehyde. Embedment in each case was in Vestopal W. Contrasting was done with combinations of uranyl acetate and lead hydroxide.

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Effect of Computerized Auditory Training on Speech Perception of Adults With Hearing Impairment

Perspectives on Aural Rehabilitation and Its Instrumentation ◽

10.1044/arri20.3.91 ◽

2013 ◽

Vol 20 (3) ◽

pp. 91-106 ◽

Cited By ~ 6

Author(s):

Rachel Pizarek ◽

Valeriy Shafiro ◽

Patricia McCarthy

Keyword(s):

Hearing Loss ◽

Speech Perception ◽

Literature Review ◽

Low Cost ◽

Experimental Designs ◽

Auditory Training ◽

Hearing Impairments ◽

Communicative Disorders ◽

And Training

Computerized auditory training (CAT) is a convenient, low-cost approach to improving communication of individuals with hearing loss or other communicative disorders. A number of CAT programs are being marketed to patients and audiologists. The present literature review is an examination of evidence for the effectiveness of CAT in improving speech perception in adults with hearing impairments. Six current CAT programs, used in 9 published studies, were reviewed. In all 9 studies, some benefit of CAT for speech perception was demonstrated. Although these results are encouraging, the overall quality of available evidence remains low, and many programs currently on the market have not yet been evaluated. Thus, caution is needed when selecting CAT programs for specific patients. It is hoped that future researchers will (a) examine a greater number of CAT programs using more rigorous experimental designs, (b) determine which program features and training regimens are most effective, and (c) indicate which patients may benefit from CAT the most.

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Taking Care of Children After Traumatic Brain Injury

Perspectives on School-Based Issues ◽

10.1044/sbi13.3.79 ◽

2012 ◽

Vol 13 (3) ◽

pp. 79-86 ◽

Cited By ~ 1

Author(s):

Julie Haarbauer-Krupa

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Literature Review ◽

School Setting ◽

Leadership Role ◽

Speech Language Pathologists ◽

Educational Information ◽

Taking Care

AbstractPurpose: The purpose of this article is to inform speech-language pathologists in the schools about issues related to the care of children with traumatic brain injury.Method: Literature review of characteristics, outcomes and issues related to the needs serving children.Results: Due to acquired changes in cognition, children with traumatic brain injury have unique needs in a school setting.Conclusions: Speech-Language Pathologists in the school can take a leadership role with taking care of children after a traumatic brain injury and coordination of medical and educational information.

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