TY - JOUR
T1 - Vasomotor symptoms resulting from natural menopause
T2 - a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause
AU - Sarri, Grammati
AU - Pedder, Hugo
AU - Dias, Sofia
AU - Guo, Yelan
AU - Lumsden, Mary Ann
PY - 2017/9
Y1 - 2017/9
N2 - BackgroundVasomotor symptoms (VMSs) are the hallmarks of menopause, occurring in approximately 75% of postmenopausal women in the UK, and are severe in 25%.ObjectivesTo identify which treatments are most clinically effective for the relief of VMSs for women in natural menopause without hysterectomy.Search strategyEnglish publications in MEDLINE, Embase, and The Cochrane Library up to 13 January 2015 were searched.Selection criteriaRandomised controlled trials (RCTs) of treatments for women with a uterus for the outcomes of frequency of VMSs (up to 26 weeks), vaginal bleeding, and discontinuation.Data collection and analysisBayesian network meta-analysis (NMA) using mean ratios (MRs) and odd ratios (ORs).Main resultsAcross the three networks, 47 RCTs of 16 treatment classes (n = 8326 women) were included. When compared with placebo, transdermal estradiol and progestogen (O+P) had the highest probability of being the most effective treatment for VMS relief (69.8%; MR 0.23; 95% credible interval, 95% CrI 0.09–0.57), whereas oral O+P was ranked lower than transdermal O+P, although oral and transdermal O+P were no different for this outcome (MR 2.23; 95% CrI 0.7–7.1). Isoflavones and black cohosh were more effective than placebo, although not significantly better than O+P. Not only were selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) found to be ineffective in relieving VMSs, but they also had significantly higher odds of discontinuation than placebo. Limited data were available for bleeding, therefore no conclusions could be made.ConclusionFor women who have not undergone hysterectomy, transdermal O+P was the most effective treatment for VMS relief.
AB - BackgroundVasomotor symptoms (VMSs) are the hallmarks of menopause, occurring in approximately 75% of postmenopausal women in the UK, and are severe in 25%.ObjectivesTo identify which treatments are most clinically effective for the relief of VMSs for women in natural menopause without hysterectomy.Search strategyEnglish publications in MEDLINE, Embase, and The Cochrane Library up to 13 January 2015 were searched.Selection criteriaRandomised controlled trials (RCTs) of treatments for women with a uterus for the outcomes of frequency of VMSs (up to 26 weeks), vaginal bleeding, and discontinuation.Data collection and analysisBayesian network meta-analysis (NMA) using mean ratios (MRs) and odd ratios (ORs).Main resultsAcross the three networks, 47 RCTs of 16 treatment classes (n = 8326 women) were included. When compared with placebo, transdermal estradiol and progestogen (O+P) had the highest probability of being the most effective treatment for VMS relief (69.8%; MR 0.23; 95% credible interval, 95% CrI 0.09–0.57), whereas oral O+P was ranked lower than transdermal O+P, although oral and transdermal O+P were no different for this outcome (MR 2.23; 95% CrI 0.7–7.1). Isoflavones and black cohosh were more effective than placebo, although not significantly better than O+P. Not only were selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) found to be ineffective in relieving VMSs, but they also had significantly higher odds of discontinuation than placebo. Limited data were available for bleeding, therefore no conclusions could be made.ConclusionFor women who have not undergone hysterectomy, transdermal O+P was the most effective treatment for VMS relief.
KW - Menopause
KW - Uterus
KW - Network meta-analysis
KW - Hormonal treatment
U2 - 10.1111/1471-0528.14619
DO - 10.1111/1471-0528.14619
M3 - Article (Academic Journal)
C2 - 28276200
SN - 1470-0328
VL - 124
SP - 1514
EP - 1523
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 10
ER -