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Published abstract

Vasomotor symptoms due to natural menopause; systematic review and network meta-analysis (NMA) of treatment effects from the NICE Menopause Guideline

Published on 10 March 2017

Sarri, G.,Pedder, H.,Dias, S.,Guo, Y.,Lumsden, M. A.

Bjog , 2017

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BACKGROUND: Vasomotor symptoms (VMS) are the hallmarks of menopause, occurring in approximately 75% of postmenopausal women in the UK and are severe in 25%. OBJECTIVES: To identify which treatments are most clinically effective for the relief of VMS for non-hysterectomized women in natural menopause. SEARCH STRATEGY: English publications in MEDLINE, Embase and The Cochrane Library up to 13th January 2015 were searched. SELECTION CRITERIA: Randomized trials (RCTs) of treatments for women with a uterus for the outcomes of frequency of VMS (up to 26 weeks), vaginal bleeding and discontinuation. DATA COLLECTION AND ANALYSIS: Bayesian network meta-analysis (NMA) using mean ratios (MRs) and odd ratios (ORs). MAIN RESULTS: Across the three networks, 47 RCTs of 16 treatment classes (N=8326 women) were included. When compared to placebo, transdermal oestradiol and progestogen (O+P) had the highest probability of being the most effective treatment for VMS relief (69.8%) (MR: 0.23 [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, though not significantly better than O+P. Not only were SSRIs or SNRIs found ineffective in relieving VMS but they also had significantly higher odds of discontinuation than placebo. Limited data were available for bleeding therefore no conclusions could be made. CONCLUSIONS: For non-hysterectomized women, transdermal O+P was the most effective treatment for VMS relief. This article is protected by copyright. All rights reserved.