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.
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
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 .