Toward Therapeutics for Symptom Clusters During the Menopausal Transition and Early Postmenopause: A Systematic Review

Tuesday, 23 July 2013: 3:50 PM

Nancy Fugate Woods, PhD, RN, FAAN1
Ellen Sullivan Mitchell, RN, PhD2
Lori Cray, PhD, RN3
Lisa Taylor-Swanson, EAMP, BS, MS Dipl. OM (NCCAOM)4
Annette Thomas, BSN5
Rita Ismail, BSN5
Janet Schnall, MS, AHIP6
(1)Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA
(2)Family and Child Nursing, University of Washington, Seattle, WA
(3)Seattle University School of Nursing, Seattle, WA, WA
(4)Univeristy of Washington, Seattle, WA, WA
(5)Biobehavioral Nursing, University of Washington, Seattle, WA, WA
(6)Health Sciences Library, University of Washington, Seattle, WA

Learning Objective 1: 1. identify the challenges in reviewing efficacy studies related to symptom clutsers as an outcome

Learning Objective 2: 2. summarize findings of studies of Traditional Eastern medicine, including acupuncture, herbal therapies, soy and isoflavone preparations, and body-mind therapies on symptom clusters

Purpose: Systematically review clinical trials of Traditional East Asian Medicine, herbals, soy and isoflavone preparations, and body-mind therapies for managing symptoms of hot flashes and at least one additional symptom, including mood, sleep, pain, and cognitive symptoms.

Methods: Searched PubMED/Medline, CINAHL Plus, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, AMED, and Alt-Health Watch for randomized controlled trials reported in English between 2004 and 2012. Of 1193 abstracts identified, 59 trials included data on hot flash and at least one other symptom

Results: Several trials of acupuncture (13), herbals including black cohosh (18), soy and isoflavone preparations (17), and body-mind therapies (9) yielded significant effects on multiple symptoms.  Seven acupuncture trials revealed significantly reduced hot flash frequency, intensity or bother, along with improved mood and sleep.  Chinese herbal medicine significantly reduced HF frequency, and mood, sleep, and pain. Four of 9 black cohosh trials significantly improved hot flashes, sleep and mood.   Two trials of at least 60-70 mg of isoflavones daily significantly reduced vasomotor, sleep, cognitive and pain symptoms. Equol supplements of 30 mg/d for non-Equol producing women significantly reduced vasomotor, psychological and somatic symptoms. Two trials of Genistein preparations reduced hot flashes by 30-51% but not other symptoms.  Red Clover isoflavone (80 mg/d) significantly reduced hot flashes, night sweats, sleep, cognition and pain symptoms. Mindfulness and relaxation therapy significantly reduced hot flashes and sleep symptoms. Yoga significantly reduced hot flashes and improved cognitive symptoms.  Exercise trials yielded mixed results, with half significantly reducing hot flashes and one cognitive symptoms.

Conclusion: Few investigators report treatment effects in ways that allow clinicians to consider symptom clusters when prescribing therapies, despite promising therapies