Today’s treatment options

Nearly 50% of postmenopausal women with symptoms of menopause do not seek treatment1

Vasomotor Symptoms (VMS), also known as hot flushes and night sweats, are the most commonly reported symptoms of menopause. The number of women aged 40 to 65 is projected to grow; many will experience VMS and remain untreated.1,2

Research shows that women want3:

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Open and honest conversations

Identify frequency and disruptiveness with the VMS survey tool

Use of hormone therapy, the most common treatment for VMS, has been declining for many years:4,5*

A line graph shows a drop in HT days of therapy in Germany, the UK, France, Italy, and Spain. HT Prescription Volume chart_Outlines_v5
A line graph shows a drop in HT days of therapy in Germany, the UK, France, Italy, and Spain.

WHI=Women's Health Initiative.

* Data Source: IQVIA Global MIDAS 2000-2021.

† The UK left the EU on January 31, 2020.

Treatment strategies for VMS‡

Treatment Side effects§ Efficacy
Oestrogen therapy
  • Side effects include breast tenderness, vaginal bleeding, and bloating6
  • Includes a warning that refers to stroke, deep vein thrombosis, endometrial cancer,‖ and dementia; oestrogen therapy should not be used for the prevention of cardiovascular disease or dementia7
 Up to 75% reduction in frequency and significant reductions in severity.7,8
Oestrogen-progestin therapy
  • Side effects include breast tenderness, vaginal bleeding, and bloating6
  • Includes a warning that refers to stroke, deep vein thrombosis, pulmonary emboli, myocardial infarction, invasive breast cancer, and dementia;6¶ oestrogen therapy should not be used for the prevention of cardiovascular disease or dementia7
Oestrogen combined with oestrogen agonist/antagonist
  • Side effects include infection, pain, arthralgia, and headache8
  • Includes a warning that refers to stroke, deep vein thrombosis, endometrial cancer,‖ dementia, and use with additional oestrogen; oestrogen therapy should not be used for the prevention of cardiovascular disease or dementia8

Other forms of oestrogen and progestin may have different risks, such as lower risk of various thromboembolism with transdermal oestrogen vs oral oestrogen (as indicated by some observational studies).7 Oestrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman.6

 

† For side effects of specific products, please refer to product information.

 

‡ The list of treatments presented here is for illustrative purpose only, is not exhaustive, and can be different from country to country. For comprehensive list, please consult your local guidance for menopause treatment.

 

§ For side effects of specific products, please refer to product information.

 

‖ In women with a uterus who use unopposed oestrogens.6

 

¶ In postmenopausal women 65 years of age and older.6

Treatment Side effects# Efficacy
SSRI
  • Side effects include nausea, headache, and dizziness6
  • Includes warning for suicidal thoughts and behaviours in paediatrics and young adults9
 33% to 65% reduction in frequency and significant reductions in severity.10
Clonadine Side effects have included hypertension when abruptly stopped, abdominal pain, headache, hypotension, fatigue, and nausea11 The severity or composite score was improved in 4 of the 10 randomised controlled trials with clonidine.12

SSRI=selective serotonin reuptake inhibitor.

 

# For side effects of specific products, please refer to product information.

Treatment Side effects** Efficacy
Supplements and herbal therapies Evidence of safety of unregulated products is limited6 Inconsistent evidence of clinical benefit more than placebo. In a 1-year randomised controlled trial, soy, black cohosh, and other botanicals were not found to be more effective than placebo6

 

** For side effects of specific products, please refer to product information.

medical assignment

A middle-aged menopausal White woman with perspiration on her face and neck looks off to the right.

Not an actual patient.

VMS in her words

I know my hormones are changing. I just don't want it to show. medical assignment

References:

  1. Constantine GD, Graham S, Clerinx C, et al. Behaviours and attitudes influencing treatment decisions for menopausal symptoms in five European countries. Post Reprod Health 2016;22(3):112-22.
  2. Ortman JM, Velkoff VA, Hogan H. An aging nation: the older population in the United States, Current Population Reports, P25-1140. US Census Bureau, Washington, DC. 2014.
  3. Parish SJ, Nappi RE, Kingsberg S. Perspectives on counseling patients about menopausal hormone therapy: strategies in a complex data environment. Menopause 2018;25(8):937-49.
  4. Lobo R. Hormone-replacement therapy: current thinking. Nat Rev Endocrinol 2017;13(4):220-31.
  5. Astellas. VEOZAH, VEOZA. Data on File.
  6. Kaunitz AM, Manson JE. Management of menopausal symptoms. Obstet Gynecol 2015;126(4):859-76.
  7. Pinkerton JV. Hormone therapy for postmenopausal women. N Engl J Med 2020;382(5):446-55.
  8. Goldberg T, Fidler B. Conjugated estrogens/bazedoxifene (Duavee): a novel agent for the treatment of moderate-to-severe vasomotor symptoms associated with menopause and the prevention of postmenopausal osteoporosis. P T 2015;40(3):178-82.
  9. Fornaro M, Anastasia A, Valchera A, et al. The FDA “Black Box” Warning on antidepressant suicide risk in young adults: more harm than benefits? Front Psychiatry 2019;10:294.
  10. Carroll DG, Lisenby KM, Carter TL. Critical appraisal of paroxetine for the treatment of vasomotor symptoms. Int J Womens Health 2015;7:615-24.
  11. Yasaei R, Saadabadi A. Clonidine. (7-19-2022). https://www.ncbi.nlm.nih.gov/books/NBK459124/. Accessed 4-21-2023.
  12. Nelson HD, Vesco KK, Haney E, et al. Nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis. JAMA 2006;295(17):2057-71.