Aerobic exercise as a treatment for vasomotor menopausal symptoms: randomised controlled trial protocol. The effect of hormone therapy on women's quality of life in the first year of the Estonian Postmenopausal Hormone Therapy trial Reproductive hormone exposure timing and ischemic heart disease: Complicated answers to a simple question. Prevalence of menopause symptoms and their association with lifestyle among Finnish middle-aged women. A randomized controlled study of taper-down or abrupt discontinuation of hormone therapy in women treated for vasomotor symptoms Exercise participation, body mass index, and health-related quality of life in women of menopausal age. A cognitive model of menopausal hot flushes and night sweats. Hormone replacement therapy use and menopausal symptoms among women participating in a behavioral lifestyle intervention. Androgens and estrogens in relation to hot flushes during the menopausal transition. A randomized, double-blind, placebo-controlled trial of Chinese herbal medicine granules for the treatment of menopausal symptoms by stages Efficacy and safety of a soy isoflavone extract in postmenopausal women: a randomized, double-blind, and placebo-controlled study. Menopausal symptoms in Australian women. Managing menopause. Menopausal symptoms and symptom clustering in Chinese women. Effects of low-dose, continuous combined estradiol and noretisterone acetate on menopausal quality of life in early postmenopausal women. A prospective, randomized, placebo-controlled study of the dose effect of oral oestradiol on menopausal symptoms, psychological well being, and quality of life in postmenopausal Chinese women. Vaginal, endometrial, and reproductive hormone findings: randomized, placebo-controlled trial of black cohosh, multibotanical herbs, and dietary soy for vasomotor symptoms: the Herbal Alternatives for Menopause (HALT) Study Women's willingness to accept perceived risks for vasomotor symptom relief. 17β-Estradiol and natural progesterone for menopausal hormone therapy: REPLENISH phase 3 study design of a combination capsule and evidence review. Evidence-based review of therapies at the menopause. Healthcare seeking and treatment for menopausal symptoms in the United States. Isoflavone-rich or isoflavone-poor soy protein does not reduce menopausal symptoms during 24 weeks of treatment Short-term hormone therapy improves sCD40L and endothelial function in early menopausal women: potential role of estrogen receptor polymorphisms. Efficacy and tolerability of continuous combined hormone replacement therapy in early postmenopausal women Treatment of Vasomotor Symptoms of Menopause with Black Cohosh, Multibotanicals, Soy, Hormone Therapy, or Placebo Effect of black cohosh (cimicifuga racemosa) on vasomotor symptoms in postmenopausal women: a randomized clinical trial. Hormone therapy in menopausal women with cognitive complaints Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial Identifying meaningful differences in vasomotor symptoms among menopausal women Efficacy and safety of Pueraria mirifica (Kwao Kruea Khao) for the treatment of vasomotor symptoms in perimenopausal women: Phase II Study. Epidemiology of risk factors and symptoms associated with menopause in Spanish women. Hot flushes and biochemical markers for cardiovascular disease: a randomized trial on hormone therapy The effects of Chinese medicinal herbs on postmenopausal vasomotor symptoms of Australian women. A randomised controlled trial. A randomized double-blind placebo-controlled trial of a Chinese herbal medicine preparation (Jiawei Qing’e Fang) for hot flashes and quality of life in perimenopausal women Effect of soy protein supplementation on serum lipoproteins, blood pressure, and menopausal symptoms in perimenopausal women. Perimenopausal women in estrogen vasomotor trials: contribution to placebo effect and efficacy outcome A Multi-center, Randomized, Controlled and Open Clinical Trial of Heyan Kuntai Capsule (和颜坤泰胶囊) and Hormone Therapy in Perimenopausal Women The effect of dietary soy supplementation compared to estrogen and placebo on menopausal symptoms: a randomized controlled trial. Efficacy of citalopram on climacteric symptoms Efficacy and safety of DT56a compared to hormone therapy in Greek post-menopausal women Effectiveness of a modified version of the applied relaxation technique in treatment of perimenopausal and postmenopausal symptoms Endurance exercise effect on quality of life and menopausal symptoms in Nigerian women. Effects of acupuncture, applied relaxation, estrogens and placebo on hot flushes in postmenopausal women: an analysis of two prospective, parallel, randomized studies Local thermal therapy effects on menopausal symptoms and bone mineral density. Benefits of soy germ isoflavones in postmenopausal women with contraindication for conventional hormone replacement therapy. Low Dose of Transdermal Estradiol Gel for Treatment of Symptomatic Postmenopausal Women: A Randomized Controlled Trial The rationale, design, and baseline characteristics of the Women's Health Initiative Memory Study of Younger Women (WHIMS-Y) Vasomotor Symptom Relief by Soy Isoflavone Extract Tablets in Postmenopausal Women: A Multicenter, Double‐Blind, Randomized, Placebo‐Controlled Study A natural S-equol supplement alleviates hot flushes and other menopausal symptoms in equol nonproducing postmenopausal Japanese women. Characteristics of hormone therapy, cognitive function, and dementia Efficacy of exercise for menopausal symptoms: a randomized controlled trial The effect of soy-derived isoflavones over hot flushes, menopausal symptoms and mood in climacteric women with increased body mass index Ineffectiveness of Sertraline for Treatment of Menopausal Hot Flushes: A Randomized Controlled Trial Effects of acupuncture on hot flashes in perimenopausal and postmenopausal women-a multicenter randomized clinical trial Estrogen therapy selectively enhances prefrontal cognitive processes: a randomized, double-blind, placebo-controlled study with functional magnetic resonance imaging in perimenopausal and recently postmenopausal women Change in health-related quality of life over the menopausal transition in a multiethnic cohort of middle-aged women: Study of Women's Health Across the Nation Effects of the phytoestrogen genistein on hot flushes, endometrium, and vaginal epithelium in postmenopausal women: a 1-year randomized, double-blind, placebo-controlled study Efficacy and Tolerability of Desvenlafaxine Succinate Treatment for Menopausal Vasomotor Symptoms: A Randomized Controlled Trial
BACKGROUND Evidence suggests that a high proportion of perimenopausal and postmenopausal women experience vasomotor symptoms ( hot flushes/night sweats ) that can be severe and disruptive and which are the principal reason for seeking medical intervention . Hormone therapy ( HT ) is known to be an effective treatment for troublesome hot flushes/night sweats but research has raised questions about the safety of HT and there have been negative high profile media reports about its use . Consequently many women are seeking alternatives and exercise might be one such option but there is a lack of high quality evidence on its effectiveness . AIMS This RCT initially aims to investigate the feasibility/acceptability of two exercise interventions identified from our previous preference study in 165 women , and if found to be feasible/acceptable , continue to recruit sufficient women ( n=261 ) to examine the effect of these interventions on hot flushes/night sweats and other outcomes relevant to menopausal women . METHOD We aim to recruit inactive perimenopausal and menopausal symptomatic women not using HT and r and omise them to one of two exercise interventions or usual care for six months . RESULTS We will assess outcomes at baseline and 6 and 12 months from r and omisation . CONCLUSION We hope this RCT will contribute towards increasing the evidence regarding the question of whether exercise is an effective treatment for vasomotor symptoms in women not taking HT Background For postmenopausal women , the main reason to start hormone therapy ( HT ) is to reduce menopausal symptoms and to improve quality of life ( QOL ) . The aim of this study was to analyse the impact of HT on different aspects of symptom experience and QOL during a r and omised trial . A total of 1823 postmenopausal women were recruited into the Estonian Postmenopausal Hormone Therapy ( EPHT ) trial in 1999–2001 . Women were r and omised to blind HT , open-label HT , placebo or non-treatment arm . After one year in the trial , a question naire was mailed and 1359 women ( 75 % ) responded , 686 in the HT arms and 673 in the non-HT arms . Mean age at filling in the question naire was 59.8years . The question naire included Women 's Health Question naire ( WHQ ) to assess menopause specific QOL of middle-aged women together with a 17-item question naire on symptoms related to menopause , a question about painful intercourse , and a question about women 's self-rated health . Results After one year in the trial , fewer women in the HT arms reported hot flashes , trouble sleeping , and sweating on the symptom question naire . According to WHQ , women in the HT arms had fewer vasomotor symptoms , sleep problems , and problems with sexual behaviour , but more menstrual symptoms ;  HT had no effect on depression , somatic symptoms , memory , attractiveness , or anxiety . A smaller proportion of women reported painful intercourse in the HT arms . There were no significant differences between the trial arms in women ’s self-rated subjective health . Conclusions The results from the EPHT trial confirm that HT is not justified for treating symptoms , other than vasomotor symptoms , among postmenopausal women . WHQ proved to be a useful and sensitive tool to assess QOL in this age group of women Premenopausal women have a relatively lower risk of ischemic heart disease ( IHD )  compared to age matched men and this gender gap narrows after menopause . The observation that the onset of IHD occurs 10 years later in women than it does in men is said to suggest that endogenous reproductive hormones play a protective role . Indeed , animal models and human epidemiological studies suggest that oophorectomy is a risk factor for accelerated IHD . In animal models , hormone therapy ( HT ) has anti-atherosclerotic effects after oophorectomy , HT in the form of oral contraceptives ( OCs ) prevents atherosclerosis in anovulatory cycling women , and large numbers of premenopausal women taking OCs have relative safety from an IHD st and point ( 1 ) . Further , observational epidemiological studies in humans have consistently demonstrated protective effects for IHD among HT users . Such studies are typically performed on relatively younger women where  HT  is prescribed for  vasomotor symptoms during menopausal transition or shortly following menopause . In contrast , clinical trials in older , postmenopausal and often asymptomatic women have demonstrated no overall benefit and early adverse effects when r and omized to a variety of forms of HT ( 1 ) . These data discrepancies have called into question the validity of the reproductive hormone estrogen protection hypothesis , and raise the alternative possibility that  HT efficacy may differ according to the timing of exposure . Stated as a simple question , is the effect of HT on the risk of IHD in relatively young pre- or early menopausal women with vasomotor symptoms , different than it is in older , fully menopausal women ? Data from the Women ’s Ischemia Syndrome Evaluation ( WISE ) , a prospect i ve multi-center NHLBI-sponsored study design ed to explore female-specific pathophysiology in a large sample of women undergoing coronary angiography for suspected IHD ( 2 ) , may shed light on this controversy . These new data , prospect ively obtained using novel methods , including detailed reproductive health question naires , menopausal adjudication algorithms , and quantitative coronary angiography as a measure of atherosclerosis , allow a more precise inspection of this question . However , to answer this simple question we need to first answer others . Specifically , how can we integrate and underst and the findings from the available observational , animal and clinical trial data ? And to interpret these data other questions become relevant : 1 ) How accurately was menopause assessed in prior observational HT studies ? 2 ) Does HT in premenopausal women in the form of OC therapy confirm atherosclerosis benefit ? and 3 ) Does HT in early menopausal women confer reduced atherosclerosis and benefit on the risk of IHD BACKGROUND AND AIM OF THE STUDY The aim of this study is to report the prevalence of menopausal symptoms by severity among the Finnish female population and the association of their symptoms with lifestyle ( smoking , use of alcohol , physical activity ) and body mass index ( BMI ) . MATERIAL AND METHODS Health 2000 is a nationally representative population -based study of Finnish adults . Data were collected by home interview , three self-administered question naires and a clinical examination by a physician . This study included women aged 45 - 64 years ( n=1427 ) . All symptoms included menopause-specific symptoms . Both univariate analysis and a factor analysis based on symptom factors were performed by menopausal group . Multiple regression analysis included each symptom factor as a dependent variable and confounding and lifestyle factors ( age , education , smoking , alcohol use , physical activity , BMI , use of hormonal replacement therapy ( HRT ) and chronic disease status ) . RESULTS Over one-third ( 38 % ) of the premenopausal , half of the perimenopausal , and 54 % of both postmenopausal and hysterectomized women reported bothersome symptoms . The difference between pre- and perimenopausal women was largest and statistically most significant in the case of back pain and hot flushes . Physically active women reported fewer somatic symptoms than did women with a sedentary lifestyle . Smoking was not related to vasomotor symptoms . CONCLUSION Bothersome symptoms are common in midlife , regardless of menopausal status . Inverse association between physical activity and menopausal symptoms needs to be confirmed in r and omized trials Objective : The aim of this study was to investigate whether tapering down of combined estrogen plus progestogen therapy ( EPT ) reduced the recurrence of hot flashes and resumption of therapy compared with abrupt discontinuation . A secondary aim was to evaluate whether health-related quality of life ( HRQoL ) was affected after discontinuation of EPT and to investigate the possible factors predicting resumption of EPT . Methods : Eighty-one postmenopausal women undergoing EPT because of hot flashes were r and omized to tapering down or abrupt discontinuation of EPT .  Vasomotor symptoms were recorded in self-registered diaries , and resumption of hormone therapy ( HT ) was asked for at every follow-up . The Psychological General Well-being Index was used to assess HRQoL. Results : Neither the number nor the severity of hot flashes or HRQoL or frequency of resumption of HT differed between the two modes of discontinuation of EPT during up to 12 months of follow-up . About every other woman had resumed HT within 1 year . Women who resumed HT after 4 or 12 months reported more deteriorated HRQoL and more severe hot flashes after discontinuation of therapy than did women who did not resume HT . Conclusions : Women who initiate EPT  because of hot flashes may experience recurrence of vasomotor symptoms and impaired HRQoL after discontinuation of EPT regardless of the discontinuation method used , abrupt or taper down . Because , in addition to severity of flashes , decreased well-being was the main predictor of the risk to resume HT , it seems important to also discuss quality of life in parallel with efforts to discontinue HT BACKGROUND Menopausal symptoms can affect women 's health and wellbeing . It is important to develop interventions to alleviate symptoms , especially given recent evidence result ing in many women no longer choosing to take hormone replacement therapy . Exercise may prove useful in alleviating symptoms , although evidence on its effectiveness has been conflicting . AIM To examine the association between exercise participation , body mass index ( BMI ) , and health-related quality of life in women of menopausal-age . DESIGN OF STUDY Survey of women of menopausal age . SETTING West Midl and s , Engl and . METHOD Women aged 46 - 55 years ( n = 2399 ) registered with six general practice s in the West Midl and s were sent a question naire containing items relating to demographics , lifestyle factors , weight , height , exercise participation , menopausal bleeding patterns , and health-related quality of life ( including vasomotor symptoms ) . RESULTS One thous and two hundred and six ( 50.3 % ) women replied . Women who were regularly active reported better health-related quality of life scores than women who were not regularly active ( P<0.01 for all significant subscales ) . No difference in vasomotor symptoms was recorded for exercise status . Women who were obese reported significantly higher vasomotor symptom scores than women of normal weight ( P<0.01 ) . Women who were obese reported significantly higher somatic symptoms ( P<0.001 ) and attractiveness concern scores ( P<0.001 ) than women of normal weight or those who were overweight . CONCLUSION The data suggest a positive association between somatic and psychological dimensions of health-related quality of life and participation in regular exercise .  Women with BMI scores in the normal range reported lower vasomotor symptom scores and better health-related quality of life scores than heavier women . Further evidence from high- quality r and omised controlled trials is required to assess whether exercise interventions are effective for management of menopausal symptoms Hot flushes and night sweats ( HF/NS ) are commonly experienced by mid-aged women during the menopause transition . They affect approximately 70 % of women but are regarded as problematic for 15 - 20 % largely due to physical discomfort , distress , social embarrassment , and sleep disturbance . There is a need for effective and acceptable nonmedical treatments for menopausal symptoms due to the declining use of hormone therapy ( HT ) following publication of the Women 's Health Initiative and other prospect i ve studies which associated HT use with increased risk of stroke and breast cancer . HF/NS are an example of a physiological process embedded within , and moderated by , psychological processes , as evidence d by discrepancies between subjective experiences and physiologically measured symptoms . We describe a cognitive model of menopausal hot flushes that can explain symptom perception , cognitive appraisal , and behavioral reactions to symptoms . Theoretically , the model draws on symptom perception theory , self-regulation theory , and cognitive behavioral theories . The model can be used to identify the variables to target in psychological interventions for HF/NS and to aid underst and ing of possible mediating factors . As part of Phase II intervention development , we describe a cognitive behavioral treatment which links the bio-psycho-social processes specified in the model to components of the intervention BACKGROUND The decision to take hormone replacement therapy ( HRT ) is a choice many women encounter when entering menopause . The purpose of this study was to examine the choice to take HRT while participating in a lifestyle intervention to reduce cardiovascular risk through the menopause . METHODS The Women 's Healthy Lifestyle Project is a r and omized clinical trial design ed to examine whether a behavioral lifestyle intervention can decrease the expected rise in cardiovascular risk through the menopause . Participants ( N = 535 ) completed question naires and were interviewed regarding menopausal symptoms , menopausal status , hot flashes , and  HRT  use at baseline and 54 months . RESULTS The intervention was successful in preventing risk elevation through the 54-month visit . At the final visit , there was no difference between the intervention and control groups in the percentage who had become postmenopausal ( 32.9 % vs 35.0 % , respectively ) , there was no difference between control and intervention with  HRT  use , with 31.2 % reporting use of HRT , and there was no difference between groups with menopausal symptoms . The women started HRT an average of 6 months after they missed a period . Baseline risk factors did not predict HRT use at the 54-month visit . CONCLUSIONS A sizable number of women reported HRT use . The decision to use HRT was not influenced by the lifestyle intervention or their baseline cardiovascular risk , and these women started HRT very early in the peri- to postmenopause . Further , weight loss in the perimenopause did not affect menopausal symptoms In this paper , the association of hormones to vasomotor complaints during the menopausal transition is discussed . Fifty-seven regularly menstruating women without history of hormone replacement therapy ( HRT )  were selected for a longitudinal , prospect i ve study around the menopausal transition . The mean age at the start of the study was 51.3 ( + /-2.0 ) years . At intervals of 12 months all women went through a semi-structured interview and filled in question naires .  Venous blood sample s were collected every 12-month for analyses of estradiol ( E2 ) , testosterone , and rostendione , dehydroepi and rosterone-sulphate ( DHEA-S ) , follicle stimulating hormone ( FSH ) , thyrotropin ( TSH ) , and luteinizing hormone ( LH ) . Vasomotor complaints were tested using questions about hot flushes and bouts of sweating in terms of occurrence , frequency and degree of distress . Forty-six percent of the subjects reported hot flushes and bouts of sweating before menopause , increasing to 67 % during the first year after menopause and 49 % in the second year postmenopause . Low levels of estradiol and high levels of FSH were associated with vasomotor complaints before menopause . During menopause high levels of TSH were related to vasomotor complaints . The first year after menopause , women , who at this point achieved hot flushes , were characterised by high levels of E2 , but declining and low levels of FSH , but increasing . Postmenopausal , high levels of testosterone and DHEA-S seemed to protect against vasomotor symptoms . Our most important finding was , that among women who achieved hot flushes at the first assessment postmenopause , the high and rogen levels was a significant predictor of recovery from hot flushes at the last assessment , 1 year later Objective : The study aims to evaluate the effectiveness and safety of Chinese herbal medicine granules Danzhi Qing’e formula ( DZQE ) , Erzhi formula ( EZ ) , and their combination ( Combined formula ) in the treatment of menopausal symptoms at different stages of menopause . Methods : Women between the ages of 40 to 60 years , who met menopausal symptoms diagnostic criteria and experienced hot flushes at least 14 times/week in the last 4 weeks , were recruited to participate in a stratified r and omized , double-blind , placebo-controlled  clinical trial ( n = 389 ) . They received a treatment period of 8 weeks and were followed up for 4 weeks . Participants were categorized into two subgroups : 197 in the perimenopausal subgroup ( menstrual disorder to 1 y after amenorrhea ) and 192 in the early postmenopausal subgroup ( 1 - 5 y after amenorrhea ) . Participants were r and omly assigned to placebo or one of the three herbal formula treatments . The primary outcome instrument was the Menopause-Specific Quality of Life ( MENQOL ) question naire . Results : When analyzing the two subgroups together , DZQE markedly decreased the MENQOL total score at the end of 12th week with statistical significance ( P = 0.02 ) and improved vasomotor symptoms after 8 weeks treatment and 4 weeks follow-up ( P < 0.05 ) . What is more , the combined formula also greatly improved the participants ’ vasomotor symptoms compared with placebo after the 4 weeks follow-up . No statistically meaningful difference was observed in any other outcomes among the groups . The results of subgroup analysis showed that DZQE and Combined formula were more effective than placebo in improving MENQOL total score for perimenopausal women at the end of week 12 . For typical menopausal symptoms such as hot flushes and night sweats , DZQE displayed more favorable effects on early postmenopausal participants . Compared to placebo , the DZQE both showed statistically significant differences after 8 weeks treatment and 4 weeks follow-up . Although at the end of 12th week , DZQE also had better effects than placebo in the perimenopausal subgroup on vasomotor symptoms . Participants in the EZ group did not show a significant difference of any domains in MENQOL compared with participants in the placebo group . Conclusions : The DZQE formula improves the quality of life for menopausal women , especially for those with vasomotor symptoms during the whole menopausal period . The DZQE and EZ combination formula is effective only on perimenopausal symptoms OBJECTIVE To investigate the efficacy of soy isoflavone on climacteric symptoms in postmenopausal women . DESIGN In this double-blind , r and omized , placebo-controlled study , a total of 80 women ( mean age = 55.1 years ) , who reported 5 or more hot flush episodes per day , were r and omized to receive either 250 mg of st and ardized soy extract ( Glycine max AT ) a total of 100mg/day of isoflavone ( n = 40 ) or placebo ( n = 40 ) . Exclusion criteria included : contra-indication for hormone therapy ( HT ) , chronic gastrointestinal diseases , and users of HT within the preceding 6-months . For 10-months , climacteric symptoms were evaluated using a score card and the menopausal Kupperman index . Compliance and safety were also assessed . At baseline and the end of the study , lipid and hormonal profiles , as well as vaginal , mammographic and ultrasonographic parameters were measured . The t-test , Wilcoxon test and ANOVA were used in the statistical analysis . RESULTS At baseline , the mean number of hot flushes was 9.6 + /- 3.9 per day in the isoflavone group and 10.1+/-4.9 in the placebo group ( p>0.05 ) . After 10 months , there was a significant reduction in frequency of hot flushes among isoflavone users when compared to those on placebo ( 3.1 + /- 2.3 and 5.9 + /- 4.3 , respectively ) ( p<0.001 ) . Kupperman index mean values showed a significant reduction in both groups . However , soy isoflavone was significantly superior to placebo , in reducing hot flush severity ( 69.9 % and 33.7 % , respectively ) ( p<0.001 ) . Endometrial thickness , mammography , vaginal cytology , lipids and hormonal profile did not change in both groups . No serious adverse event related to isoflavone treatment was reported . CONCLUSIONS The soy isoflavone extract exerted favorable effects on vasomotor symptoms and good compliance , providing a safe and effective alternative therapeutic for postmenopausal women OBJECTIVES To describe Australian-born women 's experience of symptoms during the natural menopause transition and the relative contribution of menopausal and health status , social factors and lifestyle behaviours . DESIGN A community based cross-sectional survey by telephone interview was carried out on a r and omly derived sample of Melbourne women . PARTICIPANTS The participants were 2000 Australian-born women , aged between 45 and 55 years . OUTCOME MEASURES A list of 22 symptoms was used . Explanatory variables were : sociodemographic variables ; menopausal and health status ; lifestyle behaviours ; attitudes to ageing and to menopause . RESULTS A 70 % response rate was achieved for eligible women who could be contacted during the study . Premenopausal women were the least symptomatic and perimenopausal women the most symptomatic . Factor analysis found seven common factors from the 22 symptoms studied . Menopausal status based on menstrual history was significantly related to two groups of symptoms : vasomotor symptoms , which increased through the menopausal transition ; and general somatic symptoms which were more frequent in the perimenopause . Analysis of variance of factor scores found fewer symptoms with increasing years of education , better self-rated health , the use of fewer non-prescription medications , the absence of chronic health conditions , a low level of interpersonal stress , the absence of premenstrual complaints , not currently smoking , exercise at least once a week , and positive attitudes to ageing and menopause . CONCLUSIONS Many factors unrelated to hormonal changes contributed to the symptoms . Longitudinal investigation is needed to determine the relative importance of hormonal , psychosocial and lifestyle variables in the aetiology of mid-life symptoms OBJECTIVE To provide up date d guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor or urogenital symptoms and on considerations related to cardiovascular disease , breast cancer , urogynaecology , and sexuality . OUTCOMES Lifestyle interventions , prescription medications , and complementary and alternative therapies are presented according to their efficacy in the treatment of menopausal symptoms . Counselling and therapeutic strategies for sexuality concerns in the peri- and postmenopausal years are review ed . Approaches to the identification and evaluation of women at high risk of osteoporosis , along with options for prevention and treatment , are presented in the companion osteoporosis guideline . EVIDENCE Published literature was retrieved through search es of PubMed and The Cochrane Library in August and September 2012 with the use of appropriate controlled vocabulary ( e.g. , hormone therapy , menopause , cardiovascular diseases , and sexual function ) and key words ( e.g. , hormone therapy , perimenopause , heart disease , and sexuality ) . Results were restricted to clinical practice guidelines , systematic review s , r and omized control trials/controlled clinical trials , and observational studies . Results were limited to publication date s of 2009 onwards and to material in English or French . Search es were up date d on a regular basis and incorporated in the guideline until January 5 , 2013 . Grey ( unpublished ) literature was identified through search ing the websites of health technology assessment and health technology assessment -related agencies , national and international medical specialty societies , and clinical practice guideline collection OBJECTIVES this paper aims to report the prevalence of symptoms in the Hong Kong Chinese perimenopausal women ; to construct reported symptoms into symptom groupings ; and to clarify whether the symptom groups are associated with menopausal status . METHODS a r and om telephone survey of perimenopausal women aged 44 - 55 years was conducted in 1996 . Eligible subjects were identified through telephone dialing of a r and om sample of the numbers listed in the residents ' telephone directory . St and ardized question naire , including a 22-item symptom check list , was administered over the telephone . The principal component analysis method followed by varimax rotation was used to examine the relations among the symptoms . RESULTS differences in the prevalence of menstrual problems across the menopausal status were noted with perimenopausal women having the most complaints . Musculoskeletal conditions were the top complaints reported by the respondents , followed by headaches and psychological symptoms . About 10 % of the women complained of hot flushes , and less than 5 % of cold sweats . Five symptom clusters , namely psychological , musculoskeletal/gastrointestinal , non-specific somatic , respiratory , and vasomotor , have been identified . After adjustment for age , the analysis of variance showed that psychological , non-specific somatic and vasomotor symptoms were significantly associated with menopausal status , while musculoskeletal and respiratory were of borderline statistical significance . CONCLUSIONS compared with pre- and post-menopausal women , perimenopausal women had the highest reports of symptom complaints . Musculoskeletal complaints were the most prevalent complaints , followed by psychological symptoms . While vasomotor symptoms were significantly associated with menopausal status , their prevalence was comparatively lower than that reported in Caucasian population OBJECTIVES To describe the effects of low dose hormonal replacement therapy ( LD-HRT ) on quality of life in early postmenopausal women , since the postmenopausal estrogen deprivation in mid age women often brings along a series of changes and symptoms , which may greatly affect quality of life . METHODS Fifty normal postmenopausal women were recruited and r and omly treated with LD-HRT , 17beta-estradiol ( 1 mg/day ) and norethisterone acetate ( 0.5 mg/day ) ( LD-HRT ) or calcium supplement ( controls ) . No significant differences in age , age at menopause , the presence of chronic diseases and socio-economic status were present in the two groups . The Women 's Health Question naire ( WHQ ) , a vali date d quality -of-life instrument for perimenopausal and postmenopausal women , was administered at baseline and after 6 and 12 weeks of treatment in both groups . RESULTS At baseline no significant differences in WHQ scores were present in the two groups . In the control group the scores in all different areas showed no significant modification either after 6 and 12 weeks of observation . Conversely , the LD-HRT group showed a significant decrease in the scores of vasomotor symptoms , somatic symptoms , anxiety/fear , depressed mood and sleep problem items . No effects on memory/concentration and menstrual symptoms areas were evident . CONCLUSION Although quality of life is also and may be mainly influenced by socio-economic and cultural factors , LD-HRT definitively can improve not only vasomotor symptoms , but also more general aspects of physical and psychological well-being of symptomatic postmenopausal women OBJECTIVES Hypoestrogenism occurring in association with the menopause may result in the development of vasomotor symptoms and it may also have a detrimental effect on psychological well being and quality of life ( QOL ) . The aims of this study were to measure menopausal symptoms , mood and QOL in postmenopausal Chinese women and to assess the effect of different doses of oestrogen on these outcome indicators . METHODS A prospect i ve , r and omized , placebo-controlled study of the effect of 1 and 2 mg oestradiol on menopausal symptoms , anxiety and depressive symptoms , and QOL in 152 postmenopausal women over a 12 month study period .  Menopausal symptoms were measured using a modified Kupperman 's scale . Anxiety and depressive symptoms and QOL were measured using the Hospital Anxiety and Depression Scales and a modification of the World Health Organization Quality of Life question naire , respectively . RESULTS Baseline scoring of vasomotor symptoms in our population was low whilst QOL scoring was relatively high . Over 12 months , after adjustment for differences in baseline scoring , there was a significant reduction in menopausal symptom scores in the 2 mg oestradiol group compared with placebo but not in the 1 mg group . There were no statistically significant changes in levels of anxiety and depression or QOL in either the 1 or the 2 mg group compared with placebo . CONCLUSIONS These results suggest that relatively few Chinese women will be expected to benefit from hormone replacement in terms of either QOL or mood . In addition , the overall benefit of treatment for vasomotor symptoms will be less for a given number of Chinese women than for Caucasians . Therefore , when considering the reasons for prescribing hormone replacement therapy in this population , protection against osteoporosis will for most women be the prime consideration Objective : To evaluate vaginal , endometrial , and reproductive hormone effects of three herbal regimens compared with placebo and hormone therapy ( HT ) . Design : This was a 1-year , r and omized , double-blind , placebo-controlled trial of 351 women , ages 45 to 55 , with two or more vasomotor symptoms per day . Women were r and omly assigned to ( 1 ) black cohosh , ( 2 ) a multibotanical containing black cohosh , ( 3 ) the same multibotanical plus dietary soy counseling , ( 4 ) HT , or ( 5 ) placebo .  Women were ineligible if they had used HT in the previous 3 months or menopausal herbal therapies in the previous month . Data on vaginal cytology and dryness were collected ( at baseline and 3 and 12 mo ) . Daily menstrual diaries were maintained by 313 women with a uterus , and abnormal bleeding was evaluated . Serum estradiol , follicle-stimulating hormone , luteinizing hormone , and steroid hormone-binding globulin were assessed ( baseline and 12 mo ) among 133 postmenopausal women . Gynecologic outcomes of the five groups were compared . Results : The five groups did not vary in baseline vaginal cytology profiles , vaginal dryness , menstrual cyclicity , or hormone profiles . The HT group had a lower percentage of parabasal cells and vaginal dryness than the placebo group at 3 and 12 months ( P < 0.05 ) . Abnormal bleeding occurred in 53 of 313 ( 16.9 % ) women . There were no differences in frequency of abnormal bleeding between any of the herbal and placebo groups , whereas women in the HT group had a greater risk than those in the placebo group ( P < 0.001 ) . Among postmenopausal women , HT significantly decreased follicle-stimulating hormone and increased estradiol ; none of the herbal interventions showed significant effects on any outcomes at any time point . Conclusion : Black cohosh , used alone or as part of a multibotanical product with or without soy dietary changes , had no effects on vaginal epithelium , endometrium , or reproductive hormones BACKGROUND Evidence that long-term hormone therapy ( HT ) may increase the risk of serious adverse events led to a sharp reduction in all HT use , including short-term use for vasomotor symptom relief . We estimated women 's willingness to accept adverse event risks in exchange for vasomotor symptom relief when risks are communicated in absolute vs. relative terms . METHODS We developed a conjoint survey to elicit preferences across benefit and risk attributes of HT . The survey was administered via the Internet to 523 U.S. women aged 46 - 60 years . Participants evaluated pairs of hypothetical treatments and indicated preferences using a Likert-based scale . Risks were presented in absolute and relative terms . Satisfaction scores for HT risks and benefits were estimated using r and om-effects , ordered-probit regression . Maximum acceptable risk ( MAR ) was calculated as the increase in risk that reduces the satisfaction score for a given level of HT benefit to 0 . RESULTS For both risk versions , the least important attribute ( smallest difference in satisfaction scores ) was night sweat frequency ; heart attack risk was the most important ( largest difference in scores ) . Participants were more willing to accept risks in return for symptom relief when shown absolute vs. relative risks , although differences in MAR were statistically significant only for breast cancer risk . MARs for breast cancer and heart attack exceeded reported rates in most cases . CONCLUSIONS Many women may be willing to accept risks to control vasomotor symptoms . However , describing risks in different , but technically equivalent , ways affects women 's willingness to trade risks for benefits Several formulations combining estrogens and progestins for hormone therapy ( HT ) have been approved worldwide for the treatment of menopausal symptoms , yet recent data indicate a decline in their use and an increase in compounded bioidentical HT . Up to now , no single product combining natural 17β-estradiol and progesterone has been approved by the US Food and Drug Administration ( FDA ) or the European Medicines Agency ( EMA ) . A phase 3 trial ( REPLENISH ) is underway to study a novel oral formulation of solubilized 17β-estradiol and natural progesterone combined in a single gelatin capsule ( TX-001HR ; TherapeuticsMD , Inc , Boca Raton , FL ) for treating vasomotor symptoms ( VMS ) in postmenopausal women . The REPLENISH trial evaluates the efficacy and safety of TX-001HR ( 4 doses ) versus placebo for the reduction of moderate to severe VMS frequency and severity at 4 and 12 weeks and evaluates the endometrial safety of the combinations at 1 year . TX-001HR contains hormones that are molecularly identical to endogenous estradiol and progesterone and is intended as an option for women who prefer bioidentical hormones ; further , it does not contain peanut oil , a common allergen . The constituents of TX-001HR , in a pharmacokinetic report , showed similar bioavailability and safety compared with reference estradiol tablets and micronized progesterone capsules administered together . Published data suggest a safer profile of estradiol and natural progesterone compared with HT containing conjugated equine estrogens and progestins . This report summarizes the methodology of the REPLENISH trial and review s the evidence suggesting clinical differences between HT containing progesterone or progestins , and estradiol or conjugated equine estrogens Background and Objective The highest level of scientific evidence available for each therapy for menopausal symptoms was sought , for example , systematic review s of r and omised controlled trials ( RCTs ) . Results There is reasonable evidence that some symptoms are modified by lifestyle , for example , cessation of smoking , exercise , reduction of alcohol , diet and alleviation of psychosocial stress . No complementary medicine , for example , phytoestrogens , black cohosh , herbal or homeopathic medicines or complementary therapies , for example , acupuncture , yoga , chiropractic manipulation , reflexology or magnetic devices have a greater effect than the usual placebo effect seen in quality blinded RCTs . Some have potential side-effects . So-called ' bioidentical hormones ' have no evidence -base and potential for harm . None of the above therapies have evidence of efficacy and long-term safety . Selective serotonin and noradrenaline re-uptake inhibitors ameliorate vasomotor symptoms and sometimes menopausal depression better than placebo . The most effective therapy for menopausal ( oestrogen ) deficiency symptoms is oestrogen which is the main component of hormone replacement therapies ( HRT ) . Compared with placebo HRT is highly effective in relieving hot flushes , night sweats , dry vagina and dyspareunia . It also improved joint pains , sexuality and sleeplessness and reduced subsequent fractures in RCTs . The increased risk of oral HRT for thromboembolism is small around menopause , for those without thrombotic risk factors , and is not elevated with non-oral routes . Cardiovascular disease may be reduced when HRT is initiated near menopause . Breast cancer risk increases after several years with the use of oral HRT containing progestogens at an annual rate of 8/10 000 ( < 0.1 % ) . No increase in breast cancer risk was seen with oestrogen-only HRT OBJECTIVES A population -based study was used to describe healthcare seeking behavior for  menopausal  symptoms and treatment among women 40 - 65 years old in the United States . METHODS Participants were recruited into the Menopause Epidemiology Study from the KnowledgePanel(SM ) , which is selected by r and om digit dialing and probability sampling from the US population . From this source , 6201 women 40 - 65 years old were contacted and 4402 women participated . From the 3135 peri- and postmenopausal women , detailed information was obtained on menopausal symptoms , healthcare seeking , medication usage , and symptom relief from the medication . RESULTS Many women ( 60 % ) reported seeking health care for their menopausal symptoms . More than half of these women sought health care in the past 12 months . Vasomotor symptoms were the most frequently reported menopause symptoms across all races/ethnicities , and the most common symptoms discussed with a health care professional . One-third of the women ( 34 % ) used only hormone therapies , 12 % used complementary and /or alternative medicines , and 16 % used both for treatment of menopausal symptoms . CONCLUSIONS This study has shown that a large number of women consult healthcare providers for menopausal symptoms , indicating these symptoms are bothersome . Yet , in the United States , there is considerable variation in the symptomatology , healthcare seeking , and use of therapies for menopausal symptoms across cultures . To alleviate these symptoms women have tried alternative treatments as well as hormone therapies , yet many women did not get complete relief of specific symptoms Objective We examined the change in menopausal symptoms in response to 24 weeks of isoflavone-rich ( 80.4 mg/day ) and isoflavone-poor ( 4.4 mg/day ) soy protein isolate treatment in perimenopausal women . Design In this double-blind 24-week study , 69 women were r and omized to treatment : isoflavone-rich soy protein ( n = 24 ) , isoflavone-poor soy protein ( n = 24 ) , or whey protein control ( n = 21 ) . A Menopausal Index was used to assess change in hot flushes and night sweats , as well as other symptoms , at baseline , week 12 , and week 24 . Results Repeated measures analysis of variance indicated no treatment effect on change in hot flush ( p = 0.18 ) and night sweat ( p = 0.92 ) frequency , whereas there was a significant decline in hot flush ( p = 0.0003 ) and night sweat ( p = 0.0007 ) frequency with time in all treatment groups . & khgr;2 analyses indicated no treatment effect on severity of hot flushes or night sweats at any time point , as well as no treatment effect on frequency or severity of other vasomotor symptoms . At the completion of the study , we found no treatment effect on retrospective perception of frequency , duration , or severity of hot flushes or night sweats . Since time had a significant effect on symptoms with all groups reporting a decline in overall symptoms , this indicated either a placebo effect or simply an improvement in symptoms during the study . Conclusion In this study , we found no evidence that isoflavone-rich or isoflavone-poor soy protein provided relief of vasomotor or of other menopausal symptoms OBJECTIVE Hormone therapy ( HT ) has been suggested to improve vascular function and inflammation in menopausal women , although not consistently . We aim ed to investigate the effects of HT on endothelial function and inflammation , especially sCD40L , in early menopausal women , and the effect of common estrogen receptor ( ER ) polymorphisms on vascular responses to HT . STUDY DESIGN Eighty-four early menopausal women ( <3 years in menopause ) with menopausal complaints eligible for HT . Forty women received transdermal 17β-estradiol plus cyclical micronized progesterone for 3 months while 44 did not ( controls ) . MAIN OUTCOME MEASURES Brachial artery flow-mediated dilation ( FMD ) and vascular inflammation markers ( sICAM , sP-Selectin and sCD40L ) . Genetic polymorphisms of ERα ( PvuII 454 - 397T > C and XbaI 454 - 351A > G ) and ERβ ( AluI 1730A > G ) were also assessed . RESULTS The two groups did not differ at baseline . Following HT , vasomotor complaints ' severity , blood pressure , LDL , sCD40L , sICAM and sP-Selectin decreased and FMD increased compared to controls ( P<0.05 for all ) . ERβ AluI A allele presence was the most important independent predictor of  HT-induced increase in FMD while ERα XbaI A allele was the only independent predictor of decrease in sCD40L . CONCLUSIONS Short-term HT in early menopausal women improved endothelial function and inflammation . Specific ER polymorphisms that were found to be main determinants of HT-induced effects on endothelium could identify subgroups of women who may benefit the most from HT Objective . Continuous combined hormone replacement therapy ( ccHRT ) based on estradiol valerate ( E2V ) and medroxyprogesterone acetate ( MPA ) is effective for relief of menopausal symptoms three years or more after the menopause . This study was undertaken to examine the efficacy and tolerability of ccHRT in early postmenopausal women ( last menstrual period 1.3 years before study entry ) . Study design . This was a 52-week , r and omized , double-blind , multinational study of ccHRT comprising three different dose combinations of E2V/MPA in 459 early postmenopausal non-hysterectomized women experiencing 30 or more moderate to severe hot flushes a week and /or vasomotor symptoms requiring treatment . Main outcomes measures . The primary endpoint was change in frequency and severity of moderate to severe hot flushes at 12 weeks . Secondary outcome measures included number of bleeding days and evaluation of tolerability . Results . The frequency of hot flushes was reduced by ≥70 % after one month ( P<0.001 for all doses at week 2 onwards ) , with little evidence of statistically different dose effects . Severity of flushing was also attenuated by  ccHRT . Mean number of bleeding days fell to < 1 per 28-day cycle at 52 weeks . Rates of amenorrhoea approached 80–90 % at the end of the study , but were significantly lower at several time points with the highest-dose regimen ( 2 mg E2V + 5 mg MPA ) than with the lower-dose options ( 1 mg E2V + 2.5 mg MPA and 1 mg E2V + 5 mg MPA ; P<0.05 ) . Adverse events declined in frequency over time with all regimens but throughout the study were more numerous with the highest-dose regimen than with lower doses ( P= 0.0002 ) . Conclusions . Continuous combined HRT was effective for the relief of climacteric symptoms in early postmenopausal women and was well tolerated Context Caution about taking estrogen for treating  postmenopausal vasomotor symptoms has led to increasing substitution of herbal regimens despite few tests of their effectiveness . Contribution The authors r and omly assigned 351 perimenopausal or postmenopausal women to herbal treatments ( black cohosh , multibotanicals , or multibotanicals plus counseling about dietary soy ) , estrogen with or without progesterone , or placebo . At 3 , 6 , and 12 months , patients receiving the herbal interventions had the same change in vasomotor symptoms as those receiving placebo ( except for more severe symptoms at 12 months for patients taking multibotanicals plus dietary soy ) . Estrogen substantially decreased vasomotor symptoms . Caution s Most participants were white and were well-educated . Implication s Herbal regimens did not reduce postmenopausal vasomotor symptoms in this sample of women . The Editors Hormone therapy remains the recommended treatment for vasomotor symptoms , but trials have shown serious risks with even short-term use ( 1 , 2 ) . The use of herbs , particularly black cohosh , multibotanical supplements , and dietary soy for menopausal symptoms has grown dramatically ( 36 ) . Few of these approaches have been scientifically evaluated . Women and providers are seeking safe , effective alternatives to hormone therapy . We design ed the Herbal Alternatives for Menopause Trial ( HALT ) to provide rigorous evidence on the efficacy and short-term safety of commonly used naturopathic approaches for management of vasomotor symptoms . Methods Design Overview and Setting HALT was a 1-year double-blind , r and omized , controlled trial design ed to investigate the effects of 3 naturopathic approaches for  vasomotor symptom relief and hormone therapy compared with placebo . Study methods have been described elsewhere ( 7 ) . The Group Health Institutional Review Board approved this study , and a data and safety monitoring committee monitored it . The study was conducted at Group Health , an integrated health plan in Washington State . Participants Eligibility criteria were as follows : age 45 to 55 years ; late menopausal transition ( 1 skipped menses within the preceding 12 months ) or postmenopausal ( no bleeding within 12 months , or follicle-stimulating hormone level > 20 IU/mL if patient had undergone hysterectomy without bilateral oophorectomy ) ; and 2 or more vasomotor symptoms per day over 2 weeks ( 6 moderate to severe symptoms ) . Women in menopausal transition were included because many are highly symptomatic and trial data are lacking for this group . Exclusion criteria were the following : contraindications to hormone therapy ; use of hormone therapy or oral contraceptives within 3 months before the trial ; use of herbal medicines for menopausal symptoms within 1 month before the trial ; soy allergy ; bilateral oophorectomy ; history of breast cancer ; and nonadherence during the run-in period ( < 80 % of capsules taken ) . From May 2001 through August 2003 , women were recruited by using direct mail . Screening calls determined initial eligibility . Women attended an orientation visit at which eligibility was confirmed , physical measurements were collected , and placebo medication and question naires for the 2-week run-in period were provided . R and omization and Interventions Participants were r and omly assigned by using SAS software ( SAS Institute , Inc. , Cary , North Carolina ) , stratified by previous hormone therapy and hysterectomy ; block sizes within strata ranged from 5 to 25 . Treatment assignments were sent to the University of Washington Research Pharmacy , where medications were bottled and labeled with a sequential identification number without treatment group indication . At the r and omization visit , vasomotor symptom diaries and medication counts were examined to confirm eligibility and adherence . The study nurse determined the appropriate stratum , assigned the participant the next study number in that stratum without knowledge of group assignment , and distributed study medications . The publication of results from the Women 's Health Initiative ( WHI ) estrogenprogestin trial ( 2 ) raised new concerns about the safety of estrogen therapy . New study participants were given the choice of 5-arm ( including hormone therapy ) versus 4-arm ( no hormone therapy ) r and omization . Current participants gave consent again , incorporating risk estimates from the WHI , and were given the option of finding out whether they had been assigned to hormone therapy ; 16 were unblinded , 1 discontinued use of the study drug , and all remained enrolled . Following publication of the WHI Memory Study ( 8 , 9 ) , we informed participants of those findings and restricted r and omization to herbs and placebo . No further women were unblinded or discontinued use of the study drug . Naturopathic medicine provided the model for study interventions . The herbal products , doses , and soy diet were based on approaches used by naturopaths when the study was design ed ( 7 ) . The study groups were as follows : 1 ) black cohosh  ( Actaea racemosa or Cimicifuga racemosa , 160 mg daily ; 2.5 % triterpene glycosides ; 70 % ethanol extract ) ; 2 )  multibotanical ;  3 )  multibotanical plus soy diet counseling ; 4 ) conjugated equine estrogen , 0.625 mg daily , with ( for women with a uterus ) or without ( for women without a uterus ) medroxyprogesterone acetate , 2.5 mg ; and 5 ) placebo . The multibotanical delivered daily doses of the following : black cohosh , 200 mg ; alfalfa ( Medicago sativa ) , 400 mg ; boron , 4 mg ; chaste tree ( Vitex agnus-castus ) , 200 mg ; dong quai ( Angelica sinensis ) , 400 mg ; false unicorn ( Chamaelirium luteum ) , 200 mg ; licorice ( Glycyrrhiza glabra ) , 200 mg ; oats ( Avena sativa ) , 400 mg ; pomegranate ( Punica granatum ) , 400 mg ; Siberian ginseng ( Eleutherococcus senticosus , st and ardized constituents 0.8 % eleutherosides E and B ) , 400 mg . Black cohosh was provided by Pure World , Inc. , ( Hackensack , New Jersey ) . The multibotanical , ProGyne , was purchased from Progena Professional Formulations ( Albuquerque , New Mexico ) and encapsulated to study specifications . Both companies follow current good manufacturing practice s , and single batches were used . ConsumerLab.com ( White Plains , New York ) tested the products after the study commenced . Dong quai , false unicorn , and pomegranate were not detected , suggesting that they were of poor quality or did not contain the tested marker compounds . Other marker compounds were detected in the approximate doses as labeled ( 7 ) . The Appendix Table describes the herbal products in detail . Appendix Table . Consoli date d St and ards of Reporting Trials ( CONSORT ) Requirements for Controlled Trials of Herbal Interventions To facilitate blinding , medications and lactose placebo were encapsulated to provide 2 white and 2 blue capsules to each woman , and medication boxes were labeled with a unique identification number that did not indicate study group . The soy food intervention was modeled after a successful 5-a-day intervention ( 10 ) . We chose soy foods because of uncertainty about the efficacy of isoflavone supplements and because naturopaths commonly recommend whole soy foods . Participants received 5 telephone calls from a clinical dietitian and a 34-page booklet recommending 2 soy food servings per day ( 12 to 20 g of soy protein ) ( 7 ) . Other participants received 1 telephone call and a similar booklet reinforcing fruit and vegetable intake . Participants were instructed not to discuss dietitian calls with study nurses and were unaware that soy counseling was linked to the multibotanical . Outcomes and Measurements The primary outcomes were change from baseline ( measured over 2-week run-in period ) to 3 , 6 , and 12 months ( each measured for 4 weeks ) and change from baseline to the average for all follow-ups with regard to the mean frequency and intensity of vasomotor symptoms ( daytime hot flashes plus night sweats ) and the mean Wiklund Vasomotor Symptom Subscale score ( 11 , 12 ) . We also evaluated change from baseline to follow-up ( months 3 , 6 , and 12 and average change ) for daytime hot flash rate , night sweat rate , and the total Wiklund Menopause Symptom Scale score . Symptom diaries and global ratings of menopause symptoms are almost universally used in studies of vasomotor symptoms . Participants used a  vasomotor symptom diary  to record daytime hot flashes and night sweats , rating intensity as mild , moderate , or severe ( scale , 1 to 3 ) , as recommended by the U.S. Food and Drug Administration ( 13 ) . Women completed the Wiklund Menopause Symptom Scale , rating the severity of 13 menopausal symptoms ( sweats , hot flashes , sleep disturbance , fatigue , vaginal dryness , depression , headache , irritability , muscle/joint pain , breast tenderness , nervousness , palpitations , and dizziness/fainting on a scale of 0 ( none ) to 10 ( severe ) ( 11 ) . Soy food intake was monitored by using a self-reported , vali date d soy food question naire ( 14 ) . Follow-up Procedures Participants returned to the research clinic at 3 , 6 , and 12 months . Question naires were collected , and study medication was dispensed . Medication adherence counts were conducted by staff without participant contact and without knowledge of treatment assignment . Study nurses encouraged adherence and monitored adverse events during monthly telephone calls and at visits . Adverse events were identified through participants ' responses to the question , Have you had any medical problems or been hospitalized ? Responses were recorded and adverse events were followed until they were resolved . The study nurse determined intensity ( mild , moderate , or severe ) and whether the event was serious ( yes or no ) . Events were review ed by the study physician , who determined whether the event was study related , without knowledge of group assignment . Adverse events were coded by using the Coding Symbols for Thesaurus of Adverse Reaction Terms ( 15 ) . The Data and Safety Monitoring Committee review ed study progress and unblinded outcome and safety data 5 times . Statistical Analysis The study was powered to detect an effect of INTRODUCTION Hot flash is considered to be an early and common symptom of menopause . The present study aim ed to determine the impact of black cohosh ( Cimicifuga racemosa ) on vasomotor symptoms in postmenopausal women . METHODS This was a r and omized , double-blind , placebo-controlled clinical trial . This study was performed on 84 postmenopausal women . The participants were r and omly divided into control and intervention groups . The participants of the intervention group received one black cohosh tablet per day and the control group received one placebo tablet per day for eight weeks . The severity of vasomotor symptoms and number of hot flashes were recorded during the pre-intervention phase , and 4 and 8 weeks after the intervention . The data were analyzed using repeated measures ANOVA and ANCOVA tests . The level of significance was considered lower than 0.05 . RESULTS There was a significant difference between the two groups in terms of severity and number of hot flashes in weeks 4 and 8 by controlling the intensity of vasomotor symptoms and number of hot flashes before the intervention . Moreover , using repeated measures ANOVA , the intergroup comparison indicated a significant difference in bothgroups ( the test and control groups ) in terms of severity of vasomotor symptoms and number of hot flashes . CONCLUSION According to the findings of the study , it seems that black cohosh can be used as an effective alternative medicine in relieving menopausal vasomotor symptoms Objective : To evaluate the effects of hormone therapy ( HT ) on cognition and subjective quality of life ( QoL ) in recently postmenopausal women with cognitive complaints . Methods : Cognitive Complaints in Early Menopause Trial ( COGENT ) was a r and omized , double-blind , placebo-controlled , multicenter , pilot study of 180 healthy postmenopausal women aged 45 to 55 years , r and omly assigned to receive either placebo or conjugated equine estrogen 0.625 mg/medroxyprogesterone acetate 2.5 mg for 4 months . Outcome measures included memory , subjective cognition , QoL , sexuality , and sleep , which were assessed at baseline and month 4 . Results : The study was terminated before the expected final sample size of 275 due to a decrease in enrollment coinciding with the publication of findings from the Women ’s Health Initiative . There were no differences between groups on any cognitive or QoL measures , except for an increase in sexual interest and thoughts with HT . Modest negative effects on short- and long-term verbal memory approached significance ( p < 0.10 ) . Women with baseline vasomotor symptoms ( VMS ) showed a decrease in VMS and an improvement in general QoL , but no cognitive benefit vs placebo . Conclusions : With the power to detect an effect size of ≥0.45 , this study suggests potential modest negative effects on verbal memory that are consistent with previous hormone therapy trials in older women . GLOSSARY : BTA = Brief Test of Attention ; BVRT = Benton Visual Retention Test ; COGENT = Cognitive Complaints in Early Menopause Trial ; CRT = Educational Testing Service Card Rotation Test ; CVLT = California Verbal Learning ; FAS = Letter Fluency Test ; HERS = Heart and Estrogen/progestin Replacement Study ; HT = hormone therapy ; MFSQ = McCoy Female Sexuality Scale Question naire ; MFQ = The Memory Functioning Question naire ; PANAS = Positive and Negative Affect Scale ; PSQI = The Pittsburgh Sleep Quality Index ; QoL = subjective quality of life ; SWAN = Study of Women ’s Health Across the Nation ; UQoL = Utian Quality of Life ; VMS = vasomotor symptoms Test ; WHI = Women ’s Health Initiative ; WHISCA = WHI Study of Cognitive Aging ; WMS-R/DGT-F , MS-R/DGT-B = Digit Span Forward and Backward Subtests of the Wechsler Memory Scale – Revised Objective To evaluate the effects of electro-acupuncture ( EA ) and hormone therapy ( HT ) on vasomotor symptoms in women with a history of breast cancer . Methods Forty-five women were r and omized to EA  ( n = 27 ) for 12 weeks or HT ( n = 18 ) for 24 months . The number of and distress caused by hot flushes were registered daily before , during and up to 24 months after start of treatment . Results In 19 women who completed 12 weeks of EA , the median number of hot flushes/24 h decreased from 9.6 ( interquartile range ( IQR ) 6.6–9.9 ) at baseline to 4.3 ( IQR 1.0–7.1 ) at 12 weeks of treatment ( p < 0.001 ) . At 12 months after start of treatment , 14 women with only the initial 12 weeks of EA had a median number of flushes/24 h of 4.9 ( IQR 1.8–7.3 ) , and at 24 months seven women with no other treatment than EA had 2.1 ( IQR 1.6–2.8 ) flushes/24 h. Another five women had a decreased number of flushes after having additional EA . The 18 women with HT had a baseline median number of flushes/24 h of 6.6 ( IQR 4.0–8.9 ) , and 0.0 ( IQR 0.0–1.6 ; p = 0.001 ) at 12 weeks . Conclusion Electro-acupuncture is a possible treatment of vasomotor symptoms for women with breast cancer and should be further studied for this group of women Objective : First , to identify treatment satisfaction thresholds for interpreting treatment-related changes in vasomotor symptoms , and , second , to determine the doses of desvenlafaxine ( DVS ) ( administered as desvenlafaxine succinate ) that effectively provide relief of vasomotor symptoms considered important by menopausal women . Design : Efficacy and treatment satisfaction were assessed in 620 postmenopausal women with moderate to severe vasomotor symptoms participating in a double-blind , placebo-controlled trial and r and omly assigned to placebo or 50 , 100 , 150 , or 200 mg DVS .  Number and severity of hot flushes and number of nighttime awakenings were recorded in daily diaries for 12 weeks of treatment . At week 12 , responses to the Menopause Symptoms Treatment Satisfaction Question naire were compared with efficacy results . Results : Greater percentages of participants in the DVS groups reported being " satisfied " or " extremely satisfied " with daytime and nighttime control of hot flushes compared with placebo . The treatment satisfaction threshold , defined as the difference between the average reduction in vasomotor symptoms for women who were " neutral " versus " satisfied , " was 1.64 for moderate to severe hot flushes and 0.42 for nighttime awakenings . Statistically significant reductions with 100 , 150 , and 200 mg DVS exceeded treatment satisfaction threshold results for at least one of these thresholds , and results with 100 mg DVS compared with placebo exceeded both treatment satisfaction thresholds . Conclusions : Among menopausal women with moderate to severe vasomotor symptoms , the treatment satisfaction thresholds that were meaningful to participants were 1.64 fewer moderate to severe hot flushes per day and 0.42 fewer nighttime awakenings per night . A dose of 100 mg DVS met both of these important vasomotor symptom change thresholds OBJECTIVES To evaluate the preliminary efficacy and safety of Pueraria mirifica in the treatment of vasomotor symptoms . DESIGN Open-label study . SETTING Hat Yai Regional Hospital , Thail and . SUBJECTS Pre and postmenopausal women with vasomotor symptoms , such as hot flushes and night sweats . Other unpleasant symptoms , urogenital and psychological symptoms , were also evaluated . MATERIAL AND METHOD Patients were enrolled voluntarily and r and omly received 50 mg or 100 mg of Pueraria mirifica in capsules , once daily for six months . RESULTS Of the 48 enrolled patients , 11 cases were excluded for failing to complete the initial work-up . Thirty-seven cases were evaluated . 20 of 37 ( 54.1 % ) r and omly received a dose of 50 mg/day of Pueraria mirifica ( Group A ) , and 17 of 37 ( 45.9 % ) received 100 mg/day of Pueraria mirifica ( Group B ) . The mean of the modified Greene climacteric scale decreased from 35.6 to 26.6 , 17.2 and 15.1 in group A , while group B , declined from 32.6 to 21.0 , 14.8 and 13.6 at 1- , 3- and 6-month respectively . The mean serum estradiol , fluctuated from the baseline of 76.6 to 55.4 , 56.7 , 72.5 , 69.2 , 114.2 and 74.5 pg/ml at 1- , 2- , 3- , 4- , 5- and 6-month respectively . Whereas the mean serum follicle-stimulating hormone (FSH)/luteinizing hormone ( LH ) was stable in the range of ; 27.1/12.6 , 28.3/12.9 and 22.5/11.4 mIU/ml at baseline , 3- and 6-month respectively . CONCLUSIONS Pueraria mirifica , containing phytoestrogens , relatively alleviated the climacteric symptoms in perimenopausal women . The transient negative profiles occurred in a small number of subjects that included anemia , and liver profiles . While there was a slight decrease in lipoproteins and an increase in hormonal profiles , Pueraria mirifica demonstrates great promise in the treatment of climacteric symptoms among perimenopausal women . However , optimal doses should be clinical ly assessed , to meet appropriate individual responses OBJECTIVES ( 1 ) To assess the prevalence of risk factors for osteoporosis and cardiovascular disease and the prevalence and severity of the appearance of menopausal symptoms among Spanish menopausal women . ( 2 ) To identify the main factors responsible for this severity . ( 3 ) To detect symptom differences between perimenopausal and postmenopausal women . METHODS Cross-sectional descriptive study encompassing women aged 45 - 65 years in the whole Spanish territory . The study population sample was collected through r and om sampling . A total of 10,514 women were included . The sociodemographic , medical history and lifestyle data were assessed by means of a survey . The Kupperman scale was used to assess the severity of menopausal symptoms . RESULTS The prevalence of risk factors for osteoporosis and cardiovascular disease were 67.6 % and 74.8 % , respectively . The most common risk factors were physical inactivity ( 53.6 % ) , obesity ( 44.3 % ) , arterial hypertension ( 36.6 % ) , hypercholesterolemia ( 31.4 % ) , low calcium intake ( 30.1 % ) and smoking ( 28.7 % ) . The predominant symptoms experienced by menopausal women were hot flushes ( 51.4 % ) , insomnia ( 45.7 % ) and irritability ( 42.2 % ) . These were severe in 3.3 % of the sample , moderate in 27.3 % , mild in 24.6 % while 44.8 % had no symptoms . The prevalence of joint pain ( 40.1 % ) and depressive mood ( 40 % ) was higher in perimenopausal than in postmenopausal women . Logistic regression analysis showed that there were differences for age , BMI , smoking , social class and poor consumption of dairy products in the severity of menopausal symptoms . CONCLUSIONS A high prevalence of risk factors for osteoporosis and cardiovascular disease was observed in our study . The main factors contributing to more severe menopausal symptoms were age , BMI , smoking social class and poor consumption of dairy products . In general , postmenopausal women presented significantly higher rates of menopausal symptoms when compared to perimenopausal women Introduction Menopausal hot flushes may affect the responses of various vascular risk factors to hormone therapy ( HT ) . We compared the responses of biochemical markers for cardiovascular diseases to HT in recently postmenopausal women with tolerable or intolerable hot flushes . Methods Healthy , non-smoking freshly postmenopausal women ( n = 150 ) with no previous HT use were studied . Seventy-two women reported intolerable hot flushes ( ≥7 moderate/severe episodes/day ) and 78 women tolerable hot flushes ( ≤3 mild episodes/day ) . The participants were treated in r and omized order with either transdermal estradiol gel ( 1 mg ) , oral estradiol valerate ( 2 mg ) with or without medroxyprogesterone acetate ( 5 mg ) , or placebo for 6 months . Treatment-induced changes in lipids , lipoproteins , apolipoproteins , sex hormone binding globulin ( SHBG ) and high-sensitivity C-reactive protein were compared . The trial is registered in the US National Institutes of Health Clinical Research Registry ( no. NCT00668603 ) . Results Pretreatment hot flush status was not related to the responses of these markers to different forms of HT . However , when all active regimens were evaluated together as a post-hoc analysis , 7/10 markers showed a tendency toward greater beneficial changes in women with intolerable hot flushes . Furthermore , in women with intolerable hot flushes and with HT use , the increases in SHBG ( Spearman 's rho = − 0.570 , p < 0.001 ) were related to the reductions in hot flushes during the use of HT . Conclusions Hot flushes appear to be no significant determinant for the responses of vascular  markers to HT use OBJECTIVE To evaluate the effects of a defined formula of Chinese medicinal herbs ( CMH ) on menopausal symptoms . DESIGN A double-blind r and omised placebo-controlled trial . METHODS Between August 1998 and April 1999 , 55 postmenopausal Australian women recruited from an urban population completed 12 weeks of intervention with either a defined formula of CMH ( n = 28 ) or placebo ( n = 27 ) taken twice daily as a beverage . MAIN OUTCOME MEASURES The primary end-point was change in frequency of vasomotor events ( hot flushes and night sweats ) . The secondary end-points were changes in score for the domains measured in the Menopause Specific Quality of Life ( MENQOL ) Question naire . RESULTS There was a reduction in average weekly frequency of vasomotor events with CMH ( -15 % ; 95 % CI , -31 % to + 1 % ) and with placebo ( -31 % ; 95 % CI , -42 % to -21 % ) . The difference between groups favoured the use of placebo ; however , this was not significant ( P=0.09 ) . Although significant reductions in scores for the various domains of the MENQOL Question naire were observed for both CMH and placebo , there were no significant differences between the two treatment groups for any domain . There was evidence for effect modification by previous use of natural therapies for the vasomotor , physical and sexual domains of the MENQOL Question naire : women with no prior use of natural therapies for their menopausal symptoms responded to therapy , whereas prior users did not . CONCLUSIONS The defined formula of CMH was no more effective than placebo in reducing vasomotor episodes in Australian postmenopausal women , or in improving any of the four symptom domains in the MENQOL Question naire . Three of the MENQOL Question naire domains were modified by prior use of natural therapies . This finding has implication s for future studies Objective This study aim ed to evaluate the effectiveness and safety of a Chinese herbal medicine preparation , Jiawei Qing’e Fang ( JQF ) , on menopausal symptoms in perimenopausal women . Methods A r and omized double-blind placebo-controlled trial was performed over 12 weeks in 72 perimenopausal women who reported 14 or more hot flashes per week . The participants were r and omly allocated to receive JQF or placebo for 8 weeks . Posttreatment follow-up was performed 4 weeks after intervention . The primary outcome was the Menopause-Specific Quality of Life . Secondary outcomes included hot flash and plasma lipids . Results There was greater improvement in hot flash score in the JQF group compared with the placebo group , and the difference between the two groups was statistically significant ( P = 0.048 ) . There were between-group differences in vasomotor ( P = 0.011 ) and physical ( P = 0.034 ) domains . The triglyceride ( TG ) level in the JQF group showed a significant reduction ( P = 0.036 ) in women with a baseline TG greater than 150 mg/dL ( 1.7 mmol/L ) . Conclusions The Chinese herbal medicine preparation JQF was found to be superior to placebo in reducing hot flashes and improving menopausal symptoms in the vasomotor and physical aspects and might have a potential benefit in reducing TG levels . The herbal medicine preparation was well tolerated , with no serious adverse events noted during the study period OBJECTIVE To investigate the effect of soy protein supplementation with known levels of phytoestrogens on cardiovascular disease risk factors and menopausal symptoms in perimenopausal women . METHODS A r and omized , double-blind crossover trial was conducted in 51 women consuming isocaloric supplements containing 20 g of complex carbohydrates ( comparison diet ) , 20 g of soy protein containing 34 mg of phytoestrogens given in a single dose , and 20 g of soy protein containing 34 mg of phytoestrogens split into two doses .  Women were r and omly assigned to one of the three diets for 6-week periods and subsequently were r and omized to the remaining two interventions to determine whether differences existed between the treatment diets for cardiovascular disease risk factors , menopausal symptoms , adherence , and potential adverse effects . RESULTS Significant declines in total cholesterol ( 6 % lower ) and low density lipoprotein cholesterol ( 7 % lower ) were observed in both soy diets compared with the carbohydrate placebo diet . A significant decline in diastolic blood pressure ( 5 mm Hg lower ) was noted in the twice-daily soy diet , compared with the placebo diet . Although nonsignificant effects were noted for a number of measures of quality of life , a significant improvement was observed for the severity of vasomotor symptoms and for hypoestrogenic symptoms in the twice-daily group compared with the placebo group . No significant effects were noted for triglycerides , high density lipoprotein cholesterol or frequency of menopausal symptoms . Adherence was excellent in all groups . CONCLUSIONS Soy supplementation in the diet of nonhypercholesterolemic , nonhypertensive , perimenopausal women result ed in significant improvements in lipid and lipoprotein levels , blood pressure , and perceived severity of vasomotor symptoms . These data corroborate the potential importance of soy supplementation in reducing chronic disease risk in Western population Objective : To determine the difference , if any , in the placebo response when both perimenopausal and postmenopausal women are enrolled , compared with postmenopausal women alone , in a study assessing the efficacy of synthetic conjugated estrogen tablets on moderate-to-severe vasomotor symptoms ( MSVS ) . Methods : A total of 120 healthy women ( 72 active ; 48 placebo ) complaining of moderate-to-severe vasomotor symptoms were enrolled in a r and omized , placebo-controlled , double-blind , multicenter clinical trial . In all , 109 patients completed treatment to week 12 . Women were enrolled using minimal inclusion and exclusion criteria , and included perimenopausal women ( n = 34 ; 0 to 6 months since last menses ) as well as menopausal women ( n = 79 ; > 12 months since last menses ) . Results : Changes in MSVS in the intent-to-treat ( ITT ) population showed differences between the active and placebo treatments at weeks 4 ( p < 0.022 ) , 8 ( p < 0.010 ) and 12 ( p < 0.010 ) . At week 12 , the mean percentage reduction in MSVS was 81 % for the active treatment group and 58 % in the placebo treatment group . To examine the placebo response , the ITT population was broken down into groups defined by the time since their last menses . The perimenopausal group ( 0 to 6 months since last menses ) demonstrated a consistently higher placebo response than that of the postmenopausal groups ( > 12 months since last menses ) . Conclusions : Perimenopausal women contributed to a higher placebo response , compared with the rate of response previously reported in clinical studies of estrogen replacement in postmenopausal women . Including perimenopausal women in future vasomotor symptom trials will require study population s of sufficient size to maintain the statistical power to demonstrate a difference between therapeutic response to active or placebo treatment Objective To evaluate the efficacy and safety of Heyan Kuntai Capsule ( 和颜坤泰胶囊 , HYKT ) and hormone therapy ( HT ) on perimenopausal syndromes ( PMSs ) . Methods From 2005 to 2008 , 390 women with PMSs were recruited from 4 clinic centers . The inclusion criteria included ages 40 to 60 years , estradiol ( E2 ) below 30 ng/L , and follicle stimulating hormone ( FSH ) above 40 IU/L , etc . The patients were r and omly assigned to HYKT group or HT group by r and om number table method , administrated HYKT or conjugated estrogen with/without medroxyprogesterone acetate tablets for 12 months . During treatment , the patients were interviewed quarterly , Kupperman Menopausal Index ( KMI ) scores , hot flush scores , insomnia scores , Menopause-Specific Quality of Life ( MENQOL ) scores and adverse effects were used for evaluating drug efficacy and safety respectively . The last interview was made at the end of 12-month treatment Results After treatment , KMI scores of HYKT group and HT group were both significantly decreased compared with baseline ( P < 0.01 ) and there was no significant difference between groups ( P > 0.05 ) , except that KMI of HYKT group was higher after 3-month treatment ( P < 0.05 ) . After treatment , hot flush and insomnia scores were both improved significantly in two groups ( P < 0.01 ) ; and HT had a better performance than HYKT in improving hot flush ( P < 0.05 ) . MENQOL were significantly improved in both groups after treatment ( P < 0.01 ) ; but there was no significant difference between two groups ( P > 0.05 ) . The incidence of adverse event in the HYKT group was much lower than that in the HT group ( P < 0.01 ) . Conclusions HYKT could effectively relieve PMSs and improve patients quality of life without severe adverse reactions . Although HYKT exerted curative effects more slowly than hormone , it possessed better safety profile than hormone OBJECTIVES To compare the effects of daily ingestion of dietary soy supplementation , low-dose hormone therapy ( HT ) and placebo on psychological , somatic and urogenital symptoms in postmenopausal women . STUDY DESIGN A double-blind , r and omized , controlled trial . Sixty healthy , symptomatic , postmenopausal women of 40 - 60 years of age were allocated to use dietary soy supplementation ( containing 90 mg of isoflavone ) or HT ( 1 mg estradiol and 0.5 mg norethisterone acetate ) or placebo . MAIN OUTCOME MEASURES the Menopause Rating Scale ( MRS ) was used to assess menopausal symptoms at baseline and after 16 weeks of treatment . Intention-to-treat analyses were performed using the chi-square test , Fisher 's exact test , the Kruskal-Wallis non-parametric test and analysis of variance ( ANOVA ) . RESULTS No statistically significant differences were found between the groups with respect to baseline clinical and sociodemographic characteristics . The psychological , somatic and urogenital symptoms analyzed in the MRS improved during treatment in all the groups , except for urogenital symptoms in the placebo group in which no significant changes were detected . Comparison between groups revealed a statistically significant improvement in somatic symptoms ( hot flashes and muscle pain ) in the users of HT ( -45.6 % ) and dietary soy supplementation ( -49.8 % ) . Urogenital symptoms ( vaginal dryness ) improved significantly in HT users ( -38.6 % ) and in users of the dietary soy supplementation ( -31.2 % ) . There was no statistically significant difference between the groups with respect to overall MRS score or to scores obtained in the psychological symptoms subscale . CONCLUSION Dietary soy supplementation may constitute an effective alternative therapy for somatic and urogenital symptoms of the menopause Objective : The aim of this study was to evaluate the efficacy of citalopram for climacteric symptoms and to assess the combined effect of citalopram and hormone therapy ( HT ) on climacteric symptoms in women inadequately responsive to HT alone . Design : The study included 100 postmenopausal women who were allocated into one of four groups : ( 1 ) citalopram , ( 2 ) placebo , ( 3 ) citalopram + HT , or ( 4 ) placebo + HT . The women who were unable or unwilling to take HT  were r and omly placed in groups 1 and 2 . The women who were inadequately responsive to HT  were r and omly placed in groups 3 and 4 . The initial dose of citalopram was 10 mg/day in groups 1 and 3 . After 1 week , the dose was increased to 20 mg/day . After starting the medication , follow-up visits took place during the fourth and eighth weeks of treatment . During the first and eighth weeks , women completed two question naires : a modified Kupperman index and the Menopause-Specific Quality of Life Question naire . Results : Mean hot flash scores significantly improved in all groups ( P < 0.05 ) . The reduction rates were 37 % in group 1 , 13 % in group 2 , 50 % in group 3 , and 14 % in group 4 . Psychosocial complaints and mean values on the Kupperman index significantly decreased in all groups ( P < 0.05 ) . Physical well-being significantly improved in groups 1 , 3 , and 4 ( P < 0.05 ) . The decrease in all scores was significantly greater in groups 1 and 3 compared to groups 2 and 4 ( P < 0.01 ) . Conclusion : Citalopram is an effective alternative treatment option for patients who do not want to take HT for the alleviation of climacteric symptoms . Adjuvant treatment with a selective serotonin reuptake inhibitor increases the effectiveness of HT  for the treatment of climacteric symptoms in women who had responded inadequately to HT Background : Hormone therapy ( HT ) is the treatment of choice for the alleviation of menopausal symptoms ; concerns , however , about its concomitant long-term health risks have limited its use . DT56a is a unique enzymatic isolate of soybeans . The purpose of our study was to evaluate the efficacy and safety of DT56a , compared to HT , in symptomatic post-menopausal women . Subjects and methods : Eighty-nine post-menopausal women were studied prospect ively . Women with climacteric symptoms were r and omly assigned to receive eitherDT56a ( no.=27 ) or oral low dose continuous combined HT ( no.=26 ) . Symptomatic women not wishing to receive any treatment served as controls ( no.=36 ) . Menopausal symptoms as assessed through the Kupperman index , serum lipids and lipoproteins , calcium , as well as bone mineral density ( BMD ) , endometrial thickness , and mammography were assessed at baseline and at 12 months . Results : Patients receiving HT and DT56a showed a significant and independent decrease in menopausal symptoms ( mean difference in Kupperman score , DT56a group : −3.98 , HT group −5.601 , no treatment group + 1.76 , p-value < 0.001 ) . Lumbar spine BMD T-score was significantly lower in women receiving no treatment , as opposed to the two treatment arms which showed no significant change ( No treatment , baseline : −0.60 , final : −0.85 , p=0.001 ; HT , baseline : −84 , final −0.99 , p=0.79 ; DT56a , baseline −0.51 , final : −0.76 , p=0.75 ) . No differences in femoral bone density , ET or mammography classification were detected in any of the treatment arms . Likewise , serum lipids or lipoproteins did not differ between the three groups . Conclusions : DT56a decreased menopausal symptoms significantly and in the same degree as HT Background Awareness of the risks associated with hormone therapy for menopausal symptoms has sparked a global decline in this treatment . Alternative treatments to relieve menopausal symptoms are therefore required . The applied relaxation ( AR ) technique has proven to be successful for symptom amelioration , but requires participation in 12 weekly classes . The purpose of this study was to determine the effectiveness of a modified relaxation version ( MR ) of AR for treatment of hot flashes , night sweats , and sleep disturbances . Methods We conducted a12-week , r and omized , parallel , open-label , controlled trial in perimenopausal and postmenopausal women visiting the menopausal clinic . Participants were r and omly assigned to an MR or AR group . The MR group ( n=36 ) received a single session of ( MR ) training and the AR group ( n=35 ) received conventional 12-week training . Participants were instructed to practice the techniques daily at home for 12 weeks . The main outcome was the measure on the severity scale and frequency of hot flashes , night sweats , and sleep disturbances . Results All participants completed the study .  Total severity scores in both groups decreased after 12 weeks , but there was no difference between the groups ( P=0.93 ) . The severity score for hot flashes in the MR group decreased more than in the AR group ( P=0.02 ) . The severity scores for night sweats and sleep disturbances decreased in both groups . The frequency of hot flashes , night sweats , and sleep disturbances were also decreased in both groups . Conclusion A shorter , modified version of the AR was equally effective or slightly better than the conventional AR for the relief of hot flashes , night sweats , and sleep disturbances in perimenopausal and postmenopausal women . Recommendations for future research include confirmatory studies and trials with larger sample INTRODUCTION Women in the menopausal stage of life usually have climacteric symptoms of  hot flashes ,  back pain , sleeplessness , night sweats and increased risk of cardiovascular disorders . Although physical exercises have been documented to favourably alleviate some of these problems , there 's a paucity of knowledge of their effects on menopausal women in Nigeria . OBJECTIVES This study investigated the effect of a twelve-week Endurance Exercise Programme ( EEP ) on quality of life(QOL ) and menopausal symptoms in these women . METHODS Participants were purposively recruited and assigned into perimenopausal and postmenopausal groups based on history of thier last menstrual period and from each of these groups r and omized into : perimenopausal exercise group ( PEMEG ) , postmenopausal exercise group ( POMEG ) , perimenopausal control group ( PEMCG ) postmenopausal control group ( POMCG ) .  Quality of life ( QOL ) , Menopausal symptoms - Back Pain ( BP ) and hot flashes ( HF ) among other variables , were evaluated at baseline and 4 weekly intervals . EEP consisted of a 10-station circuit of muscular and cardiovascular endurance , flexibility , coordination , abdominal and pelvic floor muscle exercises . RESULTS One hundred and seventy five menopausal women , mean age 52.3 + /- 4.1 years . Significant changes occurred between baseline and end of 12th week mean values of PEMEG for QOL : 565.9 + /- 108.8 vs 725.0 + /- 42.9 and BP 4.42 + /- 1.7 vs 1.00 + /- 0.0 . ( p= 0.000 ) . Also , in POMEG : QOL 558.3 + /- 127.7 vs 736.5 + /- 44.8 ; and BP 5.37 + /- 1.48 vs 1.88 + /- 1.18 ( p=0.000 ) . Significant changes in QOL and BP did not occur in the control groups . CONCLUSION Routine participation in endurance exercise programme is recommended for menopausal women for improved QOL Objective To assess if transdermal or oral estrogens , acupuncture and applied relaxation decrease the number of menopausal hot flushes/24 h and improve climacteric symptoms , as assessed by the Kupperman index , more than transdermal placebo treatment . Setting An outpatient clinic at a Swedish university hospital . Methods A total of 102 postmenopausal women were recruited to two studies performed in parallel . In Study I , the women were r and omized between transdermal placebo or estrogen treatment and , in Study II , between oral estrogens , acupuncture or applied relaxation for 12 weeks .  Climacteric symptoms were measured with daily logbooks on hot flushes . Women completed the assessment question naire for the Kupperman index at baseline and after 12 weeks . Results The number of flushes/24 h decreased significantly after 4 and 12 weeks in all groups except the placebo group . Both at 4 and 12 weeks , acupuncture decreased the number of flushes more ( p < 0.05 ; p < 0.01 , respectively ) than placebo . At 12 weeks , applied relaxation  decreased the number of flushes more ( p < 0.05 ) than placebo . The Kupperman index score decreased in all groups except the placebo group . The decrease in score was significantly greater in all treatment groups than in the placebo group ( p < 0.01 ) . Conclusion Acupuncture and applied relaxation both reduced the number of hot flushes significantly better than placebo and should be further evaluated as alternatives to hormone therapy in women with menopausal vasomotor complaints OBJECTIVES The aim of this study was to evaluate the effects of local thermal therapy with far-infrared rays ( FIR ) on menopausal symptoms and bone mineral density ( BMD ) in postmenopausal women . SUBJECTS AND METHODS A prospect i ve r and omized , controlled trial was conducted in female volunteers from communities in Northern Taiwan . The intervention group ( n=22 ) received local thermal therapy with the help of FIR from an FIR emitter , for approximately 20 minutes per day , twice a week , for 20 sessions . They received the therapy on their backs while lying in a supine position . The control group ( n=21 ) received no treatment . The primary outcome was the change in the Perceived Perimenopausal Disturbances Scale , design ed for the measurement of menopause-related symptoms ( MRS ) before and after completion of treatment in a 10-week period . Secondary outcome parameters included serum levels of estradiol ( E2 ) with osteocalcin ( OC ) , and calcaneal BMD by quantitative ultrasound . RESULTS After 10 weeks of intervention , MRS determined by the scale decreased in mean total scores and mean scores for vasomotor , musculoskeletal , urologic , reproductive , and psychologic domains ( p<0.05 ) , except for reproductive ( sexuality-related ) symptoms . In the control group , mean total scores and scores of each domain had no significant difference between baseline and follow-up examination after 10 weeks . There was no significant difference between the quantitative ultrasound parameters in the calcaneus , serum E2 , and OC levels either at the baseline or in the changes from the baseline between the intervention and control groups of women ( p>0.05 ) . CONCLUSIONS Local thermal therapy with FIR results in a significant reduction of MRS in  postmenopausal women . Serum E2 , OC levels , and calcaneal BMD showed no significant changes between the two groups . These results suggest that FIR local thermal therapy may be a potential alternative for the management of postmenopausal symptoms OBJECTIVE To evaluate the effects of isoflavones on vasomotor symptoms and blood lipids in postmenopausal women with contraindication for conventional hormone replacement therapy ( HRT ) . METHODS This prospect i ve , double-blind and placebo-controlled study included 50 postmenopausal women r and omly divided into two groups : 25 women on soy germ isoflavones ( 60 mg per day , capsules ) and 25 women on placebo .  Inclusion criteria included : non-vegetarian , non-asian women whose last menstruation date d at least 12 months prior to the beginning of the study , with FSH > 40 mIU/ml , hot flushes and contraindication for HRT , not using tamoxifen or antibiotic and no disease of the gastrointestinal tract . For 6 months , the Kupperman menopausal index ( KMI ) , the vaginal cytological maturation value ( MV ) and both hormonal and lipid profiles were assessed . The t-test and analysis of variance ( ANOVA ) were employed to compare the two groups . RESULTS In both groups , a decreased KI rate was observed . However , isoflavone was significantly superior to placebo in reducing hot flushes ( 44 % versus 10 % , respectively ) ( P < 0.05 ) . After 6 months , the isoflavone group showed increased estradiol levels with unchanged FSH , LH , and vaginal cytology , and a reduction of 11.8 % in LDL and an increase of 27.3 % in HDL ( P < 0.05 ) . In the placebo group , just a reduction in MV was observed after 6 months ( P < 0.05 ) . CONCLUSIONS Soy germ isoflavone exerted favorable effects on vasomotor symptoms and lipid profile , showing itself to be an interesting alternative therapy for the postmenopausal women with contraindication for conventional HRT OBJECTIVE : To investigate safety and efficacy and identify the lowest effective dose of a new transdermal estradiol ( E2 ) gel for relief of menopausal symptoms in a population of postmenopausal women . METHODS : This study was a r and omized , double-blind , placebo-controlled , multicenter , parallel-group study . Postmenopausal women with at least 60 hot flushes per week applied 0.87 g/d ( n=136 ) , 1.7 g/d ( n=142 ) , or 2.6 g/d ( n=69 ) E2 gel or placebo gel ( n=137 ) topically for 12 weeks . The changes from baseline in hot flush frequency and severity at 4 and 12 weeks and changes from baseline in vaginal atrophy symptoms at 12 weeks were examined . RESULTS : With increasing E2 doses , mean trough serum E2 increased from 17 to 29 pg/mL. By weeks 3–5 , E2 gel reduced moderate-to-severe hot flush rate by at least seven hot flushes per day ( P<.001 ) and reduced the severity score ( P<.01 ) . The numbers needed to treat for benefit for an 80 % and 100 % decrease in hot flush number were 3.2 and 6.3 for the 0.87-g/d group and 1.3 and 2.3 for the 2.6-g/d group . At week 12 , vaginal pH was more acidic and vaginal maturation index more mature compared with placebo ( P<.001 ) . The lowest dose improved most bothersome vulvovaginal atrophy symptoms ( P<.05 ) . Estradiol gel was well tolerated at the site of application and produced no unexpected adverse effects . The 0.87 g/d dose produced fewest adverse events . CONCLUSION : The 0.87 g/d dose of this new transdermal E2 gel , which delivers an estimated 0.0125 mg E2 daily , delivered the lowest effective dose for treatment of vasomotor symptoms and vulvovaginal atrophy in a population of postmenopausal women . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00391417 LEVEL OF EVIDENCE : The Women 's Health Initiative Memory Study -Younger ( WHIMS-Y ) was design ed to assess the effect of prior r and om assignment to hormone therapy ( HT ) ( conjugated equine estrogen ( CEE ) alone or CEE plus medroxyprogesterone acetate ( MPA ) ) on global cognitive function in younger middle-aged women relative to placebo . WHIMS-Y was an ancillary study to the Women 's Health Initiative ( WHI ) HT trial and enrolled 1361 women who were aged 50 - 55 years and postmenopausal at WHI enrollment . WHIMS-Y will examine whether an average of 5.4 years of HT during early menopause has longer term protective effects on global cognitive function and if these effects vary by regimen , time between menopause and study initiation , and prior use of HT . We present the study rationale and design . We describe enrollment , adherence to assigned WHI therapy , and compare risk factor characteristics of the WHIMS-Y cohort at the time of WHI enrollment to similar aged women in the WHI HT who did not enroll in WHIMS-Y. Challenges of WHIMS-Y include lower than expected and differential enrollment . Strengths of WHIMS-Y include balance in baseline risk factors between treatment groups , st and ardized and masked data collection , and high rates of retention and on-trial adherence and exposure . In addition , the telephone-administered cognitive battery showed adequate construct validity . WHIMS-Y provided an unprecedented chance to examine the hypothesis that HT may have protective effects on cognition in younger postmenopausal women aged 50 - 55 years . Integrated into the WHI , WHIMS-Y optimized the experience of WHI investigators to ensure high retention and excellent quality assurance across sites . This article is part of a Special Issue entitled Hormone Therapy Objective : To determine the safety and efficacy of an oral soy isoflavone extract for relief of  menopausal hot flushes . Design : This was a double‐blind , r and omized , parallel group , outpatient , multicenter ( 15 sites ) study . A total of 177 postmenopausal women ( mean age = 55 years ) who were experiencing five or more hot flushes per day were r and omized to receive either soy isoflavone extract ( total of 50 mg genistin and daidzin per day ) or placebo . Physical examinations and endometrial and biochemical evaluations were performed upon admission and completion . Body weight , symptoms , and safety were evaluated at all visits . Results : Relief of vasomotor symptoms was observed in both groups . Decreases in the incidence and severity of hot flushes occurred as soon as 2 weeks in the soy group , whereas the placebo group experienced no relief for the first 4 weeks . Differences between evaluable subjects in both groups were statistically significant over 6 weeks ( p = 0.03 ) . Over 12 weeks , between‐group differences approached significance ( p = 0.08 ) . Endometrial thickness evaluated by ultrasound , lipoproteins , bone markers , sex hormone‐binding globulin and follicle‐stimulating hormone , and vaginal cytology did not change in either group . Conclusions : Soy isoflavone extract was effective in reducing frequency and severity of flushes and did not stimulate the endometrium . Soy isoflavone extracts provide an attractive addition to the choices available for relief of hot flushes . ( Menopause 2000;7:236‐242 . © 2000 , The North American Menopause Society . OBJECTIVE The objective of this clinical trial was to examine the efficacy of a supplement containing natural S-(-)equol , a daidzein metabolite , in reducing  menopausal symptoms . METHODS In this multicenter , double-blind placebo-controlled trial , 160 equol nonproducing , postmenopausal Japanese women who experienced at least 1 hot flush/day were r and omly assigned to consume 10 mg/day S-(-)equol ( n=77 women )  or placebo ( n=83 women ) for 12 weeks . Participants completed a st and ardized menopausal symptom checklist and rated five common menopause symptoms by a visual analog scale at baseline , week 12 , and week 18 ( 6-week postintervention ) . Physical , blood , and urine examinations were conducted . One hundred twenty-six women completed the study . RESULTS At baseline , daily hot flush frequency was 2.9±2.1 for the S-(-)equol group and 3.2±2.4 for the placebo group . After the 12-week intervention , the S-(-)equol group had a greater decrease from baseline in hot flush frequency compared with the placebo group ( -1.9±1.8/day , -58.7 % , vs. -1.0±2.0/day , -34.5 % , p=0.009 ) . The severity of hot flushes and neck or shoulder muscle stiffness significantly decreased in the S-(-)equol group compared with the placebo group . No changes in clinical parameters or serious adverse effects were reported . CONCLUSIONS This is the first trial to show beneficial effects of a 10-mg natural S-(-)equol supplement consumed daily for 12 weeks on major menopausal symptoms , specifically , hot flushes and neck or shoulder muscle stiffness , in postmenopausal Japanese women . This supplement offers a promising alternative for management of menopausal symptoms Objectives : To examine the association between hormone therapy ( HT ) and cognitive performance or dementia , focusing on the duration and type of treatment used , as well as the timing of initiation of HT in relation to the menopause . Methods : Women 65 years and older were recruited in France as part of the Three City Study . At baseline and 2- and 4-year follow-up , women were administered a short cognitive test battery and a clinical diagnosis of dementia was made . Detailed information was also gathered relating to current and past HT use . Analysis was adjusted for a number of sociodemographic , behavioral , physical , and mental health variables , as well as APOE ε4 . Results : Among 3,130 naturally postmenopausal women , current HT users performed significantly better than never users  on verbal fluency , working memory , and psychomotor speed . These associations varied according to the type of treatment and a longer duration of HT appeared to be more beneficial . However , initiation of HT close to the menopause was not associated with better cognition . HT did not significantly reduce dementia risk over 4 years but current treatment diminished the negative effect associated with APOE ε4 . Conclusions : Current hormone therapy ( HT ) was associated with better performance in certain cognitive domains but these associations are dependent on the duration and type of treatment used . We found no evidence that HT needs to be initiated close to the menopause to have a beneficial effect on cognitive function in later life . Current HT may decrease the risk of dementia associated with the APOE ε4 allele Objective This study aims to determine the efficacy of exercise training for alleviating vasomotor and other menopausal symptoms . Methods Late perimenopausal and postmenopausal sedentary women with frequent vasomotor symptoms ( VMS ) participated in a r and omized controlled trial conducted in three sites : 106 women r and omized to exercise and 142 women r and omized to usual activity . The exercise intervention consisted of individual facility-based aerobic exercise training three times per week for 12 weeks . VMS frequency and bother were recorded on daily diaries at baseline and on weeks 6 and 12 . Intent-to-treat analyses compared between-group differences in changes in VMS frequency and bother , sleep symptoms ( Insomnia Severity Index and Pittsburgh Sleep Quality Index ) , and mood ( Patient Health Question naire-8 and Generalized Anxiety Disorder-7 question naire ) . Results At the end of week 12 , changes in VMS frequency in the exercise group ( mean change , −2.4 VMS/d ; 95 % CI , −3.0 to −1.7 ) and VMS bother ( mean change on a four-point scale , −0.5 ; 95 % CI , −0.6 to −0.4 ) were not significantly different from those in the control group ( −2.6 VMS/d ; 95 % CI , −3.2 to −2.0 ; P = 0.43 ; −0.5 points ; 95 % CI , −0.6 to −0.4 ; P = 0.75 ) . The exercise group reported greater improvement in insomnia symptoms ( P = 0.03 ) , subjective sleep quality ( P = 0.01 ) , and depressive symptoms ( P = 0.04 ) , but differences were small and not statistically significant when P values were adjusted for multiple comparisons . Results were similar when considering treatment-adherent women only . Conclusions These findings provide strong evidence that 12 weeks of moderate-intensity aerobic exercise do not alleviate VMS but may result in small improvements in sleep quality , insomnia , and depression in midlife sedentary women Background . Risk-benefit issues raised after the WHI have significantly increased the use of alternative treatments for the menopause . Despite this , data regarding the effect of soy isoflavones over mood and menopausal symptoms in high risk population s is still lacking . Objective . To evaluate the effect of soy derived isoflavones over hot flushes , menopausal symptoms and mood in climacteric women with increased body mass index ( BMI ) . Methods . Fifty symptomatic climacteric women aged 40 to 59 with increased BMI ( ≥25 ) were recruited to receive oral 100 mg/day of soy derived isoflavones ( Climasoy ® ) for 3 months  . Hot flushes ( frequency/intensity ) , menopausal symptoms ( Menopause Rating Scale [ MRS ] ) and mood ( Hamilton Depressive Rating Scale [ HDRS ] ) were evaluated at baseline and at 90 days . Results . A total of 45 women completed the study . After 3 months of soy isoflavone supplementation hot flushes significantly decreased in percentage , number and severity ( 100 % to 31.1 % ; 3.9 ± 2.3 to 0.4 ± 0.8 and 2.6 ± 0.9 to 0.4 ± 0.8 , respectively , p < 0.001 ) . MRS scores ( total and for subscales ) reflecting general menopausal symptoms also significantly decreased compared to baseline . Regarding mood , after three months total HDRS scores and the rate of women presenting depressed mood ( scores ≥ 8) significantly decreased ( 16.3 ± 5.4 to 6.9 ± 5.2 and 93.3 % to 28.9 % , respectively , p < 0.05 ) . There was no effect on blood pressure levels or BMI values after treatment . Conclusion . In this high risk climacteric population  , soy derived isoflavone treatment improved mood as well as vasomotor and general menopausal symptoms . More research is required to determine if the positive effect over mood is a direct or an indirect one through hot flush alleviation OBJECTIVE : To estimate the effect of the selective serotonin reuptake inhibitor sertraline on hot flush frequency and severity in perimenopausal and postmenopausal women . METHODS : We performed a r and omized , blinded , placebo-controlled trial in women aged 40 to 60 years with 14 or more hot flushes per week ( N=99 ) . Women were r and omly assigned initially to daily oral sertraline ( 50 mg ) or identical placebo for 2 weeks . If no substantial side effects were noted , the dose was increased to two tablets daily ( 100 mg sertraline or placebo ) and continued for an additional 4 weeks . Hot flush frequency and severity were recorded on a daily diary . Hot flush score was calculated as frequency multiplied by severity . Participants also completed question naires addressing quality of life , menopausal symptoms , sleep quality , sexual function , mood , and side effects . RESULTS : After 6 weeks of treatment , hot flush frequency decreased similarly in both the placebo ( 38 % ) and sertraline ( 39 % ) groups ( P=.94 ) . Mean hot flush scores also decreased similarly in both groups ( 41 % and 42 % , respectively , P=.86 ) . Compared with placebo , women in the sertraline group were more likely to report gastrointestinal complaints , dry mouth , and dizziness . Treatment with sertraline also result ed in greater worsening of scores on the Medical Outcomes Study ( MOS ) Short Form 36 st and ardized physical component and the global Female Sexual Function Index . Results were similar in women at least 80 % adherent to study medication . CONCLUSION : Treatment with sertraline did not improve hot flush frequency or severity in generally healthy perimenopausal and postmenopausal women , but was associated with bothersome side effects . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00283192 LEVEL OF EVIDENCE : Objective : The aim of this study was to evaluate the effectiveness of acupuncture plus usual care for relief of hot flashes and menopause-related symptoms compared with usual care alone in perimenopausal or postmenopausal women . Methods : A multicenter , r and omized , controlled trial was conducted . Perimenopausal or postmenopausal women with average hot flash scores of 10 or higher during the week before the screening visit were enrolled and r and omly divided into two groups . The treatment group received 12 sessions of acupuncture and maintained usual care for 4 weeks , whereas the control group underwent usual care alone .  Hot flash scores were calculated by multiplying frequency by severity of hot flashes recorded in a daily diary . The primary outcome was the mean change in the average 24-hour hot flash score at week 4 from baseline . The secondary outcome was the mean change in menopause-related symptoms as estimated by the Menopause Rating Scale question naire at week 4 . Follow-up assessment at week 8 was conducted in the treatment group only . Results : The mean change in the average 24-hour hot flash score was −16.57 in the treatment group ( n = 116 ) and −6.93 in the control group ( n = 59 ) , a difference of 9.64 ( P < 0.0001 ) . The total Menopause Rating Scale score , as well as the subscale scores for the psychological , somatic , and urogenital dimensions of menopause , showed significant improvement in the acupuncture group compared with the control group ( P < 0.001 ) . The mean change in the treatment group in the primary outcome was −17.58 at week 8 . Conclusions : Our results suggest that acupuncture in addition to usual care is associated with marked clinical improvement in hot flashes and menopause-related symptoms in perimenopausal or postmenopausal women Objective : Estrogen therapy ( ET ) seems to differentially effect cognitive processes in younger versus older postmenopausal women , suggesting a window of opportunity when ET is most beneficial . Cognitive improvement in younger postmenopausal women has been attributed to ET 's influence on hot flushes and sleep , but empiric examination of the mediating role of menopause symptoms versus direct effects of ET on the brain is limited . Design : In a double-blind trial , 52 women were r and omly assigned to estradiol 0.05 mg/day  ( n = 26 )  or placebo transdermal patches ( n = 26 ) for 12 weeks . Women completed tests of memory , learning , and executive functioning , and hot flush and sleep assessment s at baseline and study end . A subset of women ( five ET treated , six placebo treated ) also underwent blood oxygenation level-dependent ( BOLD ) functional magnetic resonance imaging ( fMRI ) studies . Results : Nondepressed perimenopausal and postmenopausal women were studied . The majority had hot flushes and sleep impairment . Compared with placebo , ET selectively reduced errors of perseveration during verbal recall ( P = 0.03 ) , a frontal system-mediated function , but did not influence other cognitive processes .  Women with baseline hot flushes had greater cognitive benefit with ET ( P < 0.05 ) . Cognitive benefit was not associated with sleep problems or its improvement . Measures of fMRI BOLD activation during tests of verbal and spatial working memory showed significant increases in frontal system activity with ET ( P < 0.001 ) . Conclusions : Estrogen therapy selectively improves executive functioning as demonstrated by reduced perseverative errors and prefrontal cortex activation during verbal recall tasks . Cognitive improvement with ET is associated with hot flushes , but not with sleep , suggesting that ET has a direct central nervous system effect , rather than an indirect effect mediated through improvement of sleep Objective : The aim of this study was to examine changes in health-related quality of life ( HRQL ) during the menopausal transition , controlling for chronological aging , symptoms , and other covariates . Methods : This was a prospect i ve , longitudinal study of women aged 42 to 52 years at baseline recruited at seven US sites ( N = 3,302 ) in the multiethnic Study of Women 's Health Across the Nation . Women eligible for the cohort had an intact uterus , had at least one ovary , were not currently using exogenous hormones , were either premenopausal or early perimenopausal , and were self-identified as one of the study 's design ated racial/ethnic groups . Data from the baseline interview and six annual follow-up visits are reported . HRQL was assessed with five subscales from the Medical Outcomes Study Short-Form Health Survey , with reduced functioning defined as being in the lowest 25 % on a subscale . Covariates included symptoms , medical conditions , sociodemographics variables , physical activity , and psychological factors . Results : With adjustment for baseline age , chronological aging , and relevant covariates , the odds of reduced role-physical functioning were significantly greater at late perimenopause ( odds ratio , 1.46 ; 95 % CI , 1.08 - 1.99 ) and postmenopause ( odds ratio , 1.49 ; 95 % CI , 1.09 - 2.04 ) compared with premenopause . Menopause status was unrelated to bodily pain , vitality , role-emotional , or social functioning .  Hormone therapy users were more likely to report reduced functioning . Other variables significantly related to HRQL across all domains included vasomotor symptoms , urine leakage , poor sleep , arthritis , depressed mood , perceived stress , and stressful life events . Conclusions : The menopausal transition showed little impact on HRQL when adjusted for symptoms , medical conditions , and stress Objective : To evaluate in a 12-month , prospect i ve , r and omized , double-blind , placebo-controlled study whether pure administration of the phytoestrogen genistein ( 54 mg/d ) might reduce the number and severity of hot flushes in postmenopausal women with no adverse effect on the endometrium . Design : A total of 389 participants met the main study criteria and were r and omly assigned to receive the phytoestrogen genistein ( n = 198 ) or placebo ( n = 191 ) . About 40 % of participants in both groups did not suffer from hot flushes , and the evaluation was performed in a subgroup of 247 participants ( genistein , n = 125 ; placebo , n = 122 ) . Reductions from baseline in the frequency and severity of hot flushes were the principal criteria of efficacy . Endometrial thickness was evaluated by ultrasonography . The maturation value was also used to determine hormonal action on the vaginal cells . Results : There were no significant differences in age , time since menopause , body mass index , and vasomotor symptoms between groups at baseline ( 4.4 ± 0.33 hot flushes per day in the genistein group and 4.2 ± 0.35 hot flushes per day in the control group ) . The effect was already evident in the first month and reached its peak after 12 months of genistein therapy ( −56.4 % reduction in the mean number of hot flushes ) . Furthermore , there was a significant difference between the two groups at each evaluation time ( 1 , 3 , 6 , and 12 months ) . No significant difference was found in mean endometrial thickness and maturation value score between the two groups , either at baseline or after 12 months . Conclusions : The phytoestrogen genistein has been shown to be effective on vasomotor symptoms without an adverse effect on endometrium OBJECTIVE : To compare efficacy and safety of desvenlafaxine succinate ( desvenlafaxine ) with placebo for the treatment of vasomotor symptoms . METHODS : This r and omized , double-blind , placebo-controlled trial enrolled 707 healthy , postmenopausal women experiencing 50 or more moderate-to-severe hot flushes per week . Participants r and omly received desvenlafaxine 50 , 100 , 150 , or 200 mg or placebo daily . Trial duration was 52 weeks . Primary outcomes were change from baseline in average daily number of moderate-to-severe hot flushes and in daily hot flush severity score at weeks 4 and 12 . RESULTS : Six hundred twenty women with an average of 11 moderate-to-severe hot flushes per day at baseline completed at least one on-therapy evaluation for primary efficacy end points ; 519 participants completed 12 weeks of treatment , and 368 completed the study .  Desvenlafaxine 100 mg/d achieved a significantly greater reduction compared with placebo in average daily number of hot flushes at weeks 4 ( P=.013 ) and 12 ( P=.005 ) , reaching a 64 % decrease from baseline at week 12 , and the 75 % responder rate was significantly higher for desvenlafaxine 100 mg ( 50 % ) compared with placebo ( 29 % ; P=.003 ; number needed to treat=4.7 ) at week 12 . Average daily severity of hot flushes was significantly lower in the desvenlafaxine 100-mg group compared with placebo at week 12 ( P=.020 ) . Desvenlafaxine-treated women reported significantly more treatment-emergent adverse events than placebo-treated women during the first week of therapy only . CONCLUSION : Desvenlafaxine is an effective nonhormonal treatment for vasomotor symptoms in postmenopausal women . Its tolerability profile is consistent with that of other serotonin-norepinephrine reuptake inhibitors . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00421031 LEVEL OF EVIDENCE :
Evidence was insufficient to show whether exercise is an effective treatment for vasomotor menopausal symptoms .
One small study suggested that HT is more effective than exercise .
Evidence was insufficient to show the relative effectiveness of exercise when compared with HT or yoga
BACKGROUND Evidence suggests that many perimenopausal and early postmenopausal women will experience menopausal symptoms ; hot flushes are the most common .
Symptoms caused by fluctuating levels of oestrogen may be alleviated by hormone therapy ( HT ) , but a marked global decline in its use has result ed from concerns about the risks and benefits of HT .
Consequently , many women are seeking alternatives .
As large numbers of women are choosing not to take HT , it is increasingly important to identify evidence -based lifestyle modifications that have the potential to reduce vasomotor menopausal symptoms .
OBJECTIVES To examine the effectiveness of any type of exercise intervention in the management of vasomotor symptoms in symptomatic perimenopausal and postmenopausal women .