Hormone replacement therapy patches, isoflavones, and black cohosh reduce hot flashes and night sweats

Sarri G, Pedder H, Dias S, et al. Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute of Health and Care Excellence guideline on menopause. BJOG. 2017 Mar 9. [Epub ahead of print].

Review question

In women experiencing natural menopause without hysterectomy (i.e., still have their uterus), which drug and non-drug treatments help to reduce the number of hot flashes and night sweats, also known as vasomotor symptoms?

Background

Hot flashes and night sweats are common in women going through menopause. There are several drug and non-drug treatment options. These include hormone replacement therapy, herbal medicines, and psychological therapies.

How the review was done

The researchers did a systematic review, searching for studies that were published up to January 2015.

They found 47 randomized controlled trials.

The trials included 8,326 women 45 years of age or older who were experiencing natural menopause (no period for 12 months or more) and had an intact uterus.

Treatments that were compared with placebo included hormone replacement therapy patches or pills containing estrogen plus progestogen; other hormone replacement therapies (e.g., isoflavones); antidepressants (i.e., selective serotonin-reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors); and black cohosh (i.e., plant root).

The studies measured the frequency of hot flashes and night sweats and side-effects like vaginal bleeding.

What the researchers found

Hormone replacement therapy patches containing estrogen plus progestogen, isoflavones, and black cohosh reduced the frequency of hot flashes and night sweats more than placebo.

None of the treatments were clearly better than the others, but not all of them were compared directly with each other. Overall, the results suggest that hormone replacement patches may work the best.

Most women were able to take hormone replacement therapy (patches and pills), isoflavones, and black cohosh without experiencing serious side effects.

There were not enough trials to evaluate the effect of treatments on vaginal bleeding.

Conclusion

In women experiencing natural menopause without hysterectomy, hormone replacement therapy patches (containing estrogen plus progestogen), isoflavones, and black cohosh reduce the frequency of hot flashes and night sweats more than placebo.

Drug and non-drug treatments for hot flashes and night sweats in women experiencing natural menopause (not due to hysterectomy)

HRT = hormone replacement therapy with estrogen plus progestogen.

SSRIs/SNRIs = selective serotonin-reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors.