Consensus statement for non-hormonal-based treatments for menopausal symptoms

Non-oestrogen-based and complementary therapies for menopause

Women are living a significant portion of their adult lives in the post-reproductive phase, and many seek help for debilitating menopausal symptoms. Every individual's experience of menopausal transition is unique. Adopting a holistic approach to managing the menopause using a combination of lifestyle, hormonal, and non-hormonal interventions is key to maximise the quality of life of affected women. However, many opt to use non hormonal options or have contraindications to using hormonal therapy. Studies have shown that several pharmacological non-hormonal medications such as SSRIs, SSRI/SNRIs, Gabapentin, and Pregabalin are effective for managing vasomotor symptoms as well as other menopausal symptoms. Their main side effects are dry mouth, nausea, constipation, reduced libido, and loss of appetite. Clonidine is the only non-hormonal drug which is licenced for control of vasomotor symptoms in the UK, but has several side effects including dizziness and sleep disturbance. Cognitive Behavioural Therapy is recommended as a treatment for anxiety, sleep problems and vasomotor symptoms related to menopausal transition. Evidence for clinical efficacy and safety of herbal remedies and alternative therapies remains weak. Studies with neurokinin receptor 3 antagonists on women with hot flushes have shown improvement in vasomotor symptoms and results of large-scale studies are awaited.

Vasomotor Symptoms During Menopause: A Practical Guide on Current Treatments and Future Perspectives

Vasomotor symptoms affect as many as 80% of midlife women, but only about one in four women receive treatment due to many factors. Menopausal hormone therapy remains the most effective treatment for vasomotor symptoms, and current professional guidelines conclude that the benefits of treatment typically outweigh the risks for healthy, symptomatic women under age 60 years and those within 10 years from their final menstrual period. For women with medical comorbidities, an individualized approach to treatment is recommended. For women who cannot use or choose not to use menopausal hormone therapy, there are many evidence-based non-hormonal options available including pharmacologic therapies. This review aims to summarize treatment options for bothersome vasomotor symptoms to guide clinicians caring for midlife women.

Benefits of Black Cohosh (Cimicifuga racemosa) for Women Health: An Up-Close and In-Depth Review

Women’s health is an imminent concern worldwide, but it remains an ignored segment of research in most developing countries, and is yet to take the center stage in even developed nations. Some exclusive female health concerns revolve around both pathological and physiological aspects. These gender-specific maladies include breast, cervical, and ovarian cancers, and physiological concerns such as menopause and osteoporosis, which are often coexistent. Recently, women’s health issues, including postmenopausal syndrome, have attracted the attention of researchers and practitioners alike, opening newer pharmaceutical research and clinical avenues. Although not counted as a disease, postmenopausal syndrome (PMS) is a female health phenomenon underpinned by hormonal depletion. Enhanced life expectancy in women has added to their suffering, and pharmacological interventions are needed. Amongst the available treatment modalities, the use of numerous botanicals has emerged as an efficient health management tool for women. Cimicifuga racemosa (CR or Black Cohosh) is a plant/herb which has been traditionally exploited and extensively used by women. This review is an attempt to compile and provide a summary of the importance of CR in complementary and alternative therapies for the improvement of various disorders related to women, such as menopausal syndrome, mammary cancer, and osteoporosis. It aims to systematically highlight the bioactive constituents, pharmacology, pharmacokinetics, therapeutic potentials, quality control processes, chromatographic techniques, and possible mechanisms of action of clinically effective phytomedicine for women’s health. Various clinical trials and patents relating to CR and women’s health have been collated. Furthermore, the plant and its related products have been considered from a regulatory perspective to reveal its commercial feasibility. The present review summarizes the existing data on CR focusing on women’s health, which can help to introduce this traditional phytomedicine to the world and provide some reference for future drug development.

A study on women’s health information needs in menopausal age

Menopause is a natural event experienced by women in middle age. To help women manage this event, it is important to identify their health information needs. A study specific questionnaire was used to identify menopausal women’s health information needs and the resources and challenges related to finding information about menopause. A total of 301 women aged 48–55 years completed the questionnaire. Data were analysed using negative binomial regression and chi-square tests. The most frequently sought information was that related to breast cancer (n = 209, 69.5%), hot flushes (n = 200, 66.5%), cervical cancer (n = 194, 64.5%), non-hormonal therapies for menopausal symptoms (n = 192, 64%), laboratory tests (n = 189, 63%) and joint and muscle pain (n = 188, 62.5%). The main sources of information were audiovisual media (n = 171, 57%), obstetricians (n = 165, 55%), friends (n = 157, 52%), family (n = 157, 52%) and the internet (n = 153, 51%). The two main challenges were not knowing how to correctly access information (n = 115, 38%) and not being aware of reliable sources of information (n = 108, 36%). Therefore, it is essential for policymakers and decision-makers to provide reliable and accurate information to increase awareness and reduce anxiety of women experiencing menopause.

Review of menopause advice given to patients undergoing bilateral oophorectomy

The NICE Guideline (NG23) 2015 Menopause: Diagnosis and Management states that 'women who are likely to go through the menopause as a result of medical or surgical treatment should be offered support and information about the menopause and fertility before they have their treatment, and a referral to a Health Care Professional with expertise in the menopause'. To investigate whether discussion about the surgery causing the menopause, and advice on possible treatments had been documented, I conducted a retrospective study of women undergoing bilateral oophorectomy at a central London teaching hospital from 1st April 2018 to 30th September 2018. Only 30% of women (8 out of 27) in this study had documentary evidence of having received menopause advice around the time of bilateral oophorectomy.

The effects of nigella sativa on anthropometric and biochemical indices in postmenopausal women with metabolic syndrome

PURPOSE

This study aimed to compare the nigella sativa vs. placebo effect on anthropometric and biochemical indices in postmenopausal women with metabolic syndrome.

METHODS

This randomized, double-blinded, placebo-controlled trial was conducted as a third-phase trial among 140 menopausal women within the age of 45-60 years old, who were suffering from metabolic syndrome and were assigned to receive 500 mg nigella sativa or placebo pill once daily. Anthropometric and biochemical parameters including body weight, waist circumference, serum lipid profile, fasting blood sugar, and HbA1C were measured at baseline and 8 weeks after administration the ingredient or placebo.

RESULTS

In nigella sativa group, the serum markers such as low-density lipoprotein (115.1 ± 17.6 vs. 127.7 ± 12.6), triglyceride (158.3 ± 14.0 vs. 166.7 ± 16.0), total cholesterol (115.1 ± 17.6 vs. 127.7 ± 12.6), and fasting blood sugar (90.8 ± 16.9 vs. 113.7 ± 12.1) decreased significantly compared with the placebo (p < 0.001).

CONCLUSION

Administration of nigella sativa might be recommended for improving lipid profile and blood sugar in postmenopausal women with the metabolic syndrome.

Sustained effects of a brief and standardised acupuncture approach on menopausal symptoms: post hoc analysis of the ACOM randomised controlled trial

BACKGROUND

Our objective was to investigate whether the effect of a brief and standardised acupuncture approach persists after the end of the acupuncture treatment (post-treatment effect) and whether the anticipation of future acupuncture treatment affects menopausal symptoms (pre-treatment effect).

METHOD

This study is a post hoc analysis of data from a randomised controlled trial where women with moderate to severe menopausal symptoms were offered weekly acupuncture treatment over five consecutive weeks and randomised (1:1) to an early intervention group that received treatment immediately and a late intervention group with a 6-week delay. The acupuncture style was Western medical, administered at CV3, CV4 and bilateral LR8, SP6 and SP9. Acupuncturists were general practitioners. The effect was evaluated repeatedly during and after the interventions using scales from the validated MenoScores Questionnaire (MSQ) for hot flushes (HF), day and night sweats (DNS), general sweating (GS) and menopausal-specific sleeping problems (MSSP) with a 26-week follow-up period (corresponding to 21 or 15 weeks post-treatment for the early and late intervention groups, respectively). Multivariable linear mixed models were used to analyse the extent and duration of effects.

RESULTS

Seventy participants were included in the study. Four participants dropped out. Furthermore, one participant was excluded from the short- and long-term follow-up analyses after the insertion of a hormonal intrauterine device, and nine participants were excluded from the long-term follow-up analysis due to the initiation of co-interventions. For each of the four outcomes, the effect was sustained up to 21 weeks post-treatment with an effect size that was only slightly diminished. A small, but significant, pre-treatment effect was observed in the HF scale scores. The same trend, although not significant, was observed in the DNS and MSSP scale scores. No serious harms were reported.

CONCLUSION

This study demonstrated that the overall effect of a brief and standardised acupuncture treatment on menopause-relevant outcomes was sustained up to 21 weeks post-treatment and that there was a small pre-treatment effect.

A Nutraceutical Approach to Menopausal Complaints

The menopausal transition, or perimenopause, is characterized by menstrual irregularities, vasomotor symptoms, sleep disturbances, mood symptoms, and urogenital tract atrophy. These changes can also affect the quality of life and one’s self-esteem. Hormone replacement therapy (HRT) is considered the best option to achieve therapeutic relief of different menopausal symptoms but is usually restricted to moderate or severe symptoms. Moreover, many women refuse HRT for a variety of reasons concerning the fear of cancer and other adverse effects. According to these considerations, new topics are emerging: Dissatisfaction with drug costs and conventional healthcare, desire for personalized medicines, and the public perception that “natural is good”. In this context, nonhormonal therapies are mostly evolving, and it is not unusual that women often request a “natural” approach for their symptoms. The aim of this study is to investigate nonhormonal therapies that have been identified to reduce the menopausal symptoms.

Efficacy of a standardised acupuncture approach for women with bothersome menopausal symptoms: a pragmatic randomised study in primary care (the ACOM study)

OBJECTIVE

To investigate the efficacy of a standardised brief acupuncture approach for women with moderate-to-severe menopausal symptoms.

DESIGN

Randomised and controlled, with 1:1 allocation to the intervention group or the control group. The assessor and the statistician were blinded.

SETTING

Nine Danish primary care practices.

PARTICIPANTS

70 women with moderate-to-severe menopausal symptoms and nine general practitioners with accredited education in acupuncture.

INTERVENTION

The acupuncture style was western medical with a standardised approach in the predefined acupuncture points CV-3, CV-4, LR-8, SP-6 and SP-9. The intervention group received one treatment for five consecutive weeks. The control group was offered treatment after 6 weeks.

MAIN OUTCOME MEASURES

Outcomes were the differences between the randomisation groups in changes to mean scores using the scales in the MenoScores Questionnaire, measured from baseline to week 6. The primary outcome was the hot flushes scale; the secondary outcomes were the other scales in the questionnaire. All analyses were based on intention-to-treat analysis.

RESULTS

36 participants received the intervention, and 34 participants were in the control group. Four participants dropped out before week 6. The acupuncture intervention significantly decreased hot flushes: Δ -1.6 (95% CI [-2.3 to -0.8]; p<0.0001), day-and-night sweats: Δ -1.2 (95% CI [-2.0 to -0.4]; p=0.0056), general sweating: Δ -0.9(95% CI [-1.6 to -0.2]; p=0.0086), menopausal-specific sleeping problems: Δ -1.8 (95% CI [-2.7 to -1.0]; p<0.0001), emotional symptoms: Δ -3.4 (95% CI [-5.3 to -1.4]; p=0.0008), physical symptoms: Δ -1.7 (95% CI [-3 to -0.4]; p=0.010) and skin and hair symptoms: Δ -1.5 (95% CI [-2.5 to -0.6]; p=0.0021) compared with the control group at the 6-week follow-up. The pattern of decrease in hot flushes, emotional symptoms, skin and hair symptoms was already apparent 3 weeks into the study. Mild potential adverse effects were reported by four participants, but no severe adverse effects were reported.

CONCLUSIONS

The standardised and brief acupuncture treatment produced a fast and clinically relevant reduction in moderate-to-severe menopausal symptoms during the six-week intervention. No severe adverse effects were reported.

TRIAL REGISTRATION NUMBER

NCT02746497; Results.

Menopause Symptom Management in the United Kingdom

Menopause is a complex time in a woman's life. It is an increasingly a midlife event, when health care professionals should be aiming to optimize a woman's health for the next 30 years or so. Nurses need to be able to give up-to-date information and evidence for all forms of treatment based on a background of complex and ever-changing research. This article covers the main presenting complaints and treatments, from lifestyle to hormone replacement therapy, by drawing on guidelines from national bodies.