A Randomized Trial of Alternative Medicines for Vasomotor Symptoms of Menopause

Menopause occurs in women as part of normal aging. Many go through this transition with few or no symptoms, while some have substantial or even disabling symptoms (1). The vasomotor symptoms of hot flashes—sudden sensations of intense heat with sweating and flushing typically lasting 5 to10 minutes—and night sweats are the most prevalent perimenopausal symptoms (2). Vasomotor symptoms vary by race and ethnicity, and the late phases of the menopausal transition are associated with the highest frequency of these events (10% to 60%) (3).

A variety of treatments has been studied in randomized clinical trials (RCTs) for the management of menopausal symptoms (2). The most intensively studied treatment is estrogen. It is often combined with progestin, and when used by itself or with progestins, it is the most effective therapy for vasomotor symptoms, reducing their frequency by about 77% (4).

In 2002, results from the Women's Health Initiative's (WHI) showed that estrogen therapy with or without medroxyprogesterone increases the risk for serious disease events. This substantially dampened the enthusiasm for use of this hormone as a treatment for menopausal symptoms (5)—annual dispensed prescriptions for estrogen declined from 91 million in 2001 to 57 million in 2003 (6). The quick time to serious event” observed in the WHI and other estrogen RCTs raised further concern that even short-term use of estrogen may carry unacceptable health risks. However, some women have such severe vasomotor symptoms that they and their physicians are willing to assume the risks of estrogen.

During the post-WHI era, the search for safer and effective treatments for menopausal symptoms intensified, and a growing number of RCTs are examining the effectiveness of other hormones, antidepressants, isoflavones and other phytoestrogens, botanicals, acupuncture, and behavioral interventions (7). …