Meta-analysis compares pharmacologic options for menopausal vasomotor symptoms

A systematic review and meta-analysis of 90 randomized trials for the American College of Physicians evaluated pharmacologic treatments for vasomotor symptoms (VMS) in perimenopausal and postmenopausal women. Estrogens (with or without progestogens), conjugated estrogen with bazedoxifene, and oxybutynin reduced VMS frequency and severity versus placebo, while neurokinin receptor antagonists, SNRIs, SSRIs, gabapentin, and progestogens reduced frequency but not severity; several agents also improved quality of life or sleep. The authors note certainty of evidence was mostly low to moderate, serious adverse event data were limited, comparative data between treatments were scarce, and estrogens were rated high economic value while the NKRA fezolinetant was rated low value.

Most relevant for: Clinicians managing perimenopausal and postmenopausal women with vasomotor symptoms who are considering pharmacologic treatment options.

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