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Semin Reprod Med 2010; 28(5): 388-395
DOI: 10.1055/s-0030-1262898
© Thieme Medical Publishers

Vasomotor Symptoms: Viewpoint from the Indian Subcontinent and Management of a Common Menopausal Problem

Duru Shah1 , Sangeeta Agrawal2
  • 1Breach Candy Hospital; Jaslok Hospital & Research Centre; Sir Hurkisondas Nurrotamdas Hospital & Research Centre; The Indian College of Obstetricians & Gynecologists; and Gynaecworld and Gynaecworld Assisted Fertility Unit Mumbai, India
  • 2Department of Obstetrics and Gynecology, Bombay Hospital, India
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Publication History

Publication Date:
23 September 2010 (online)

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ABSTRACT

Vasomotor symptoms (VMS) are recognized to adversely affect the quality of life. The prevalence and the magnitude of VMS may vary across populations. Although a natural regression of VMS may be expected over a period of time, it remains the most common of symptoms for which women seek help. Menopausal hormone therapy (MHT) is currently the only treatment approved by the Food and Drug Administration that has shown uniform benefit in the management of VMS. In clinical situations when estrogen is or may be contraindicated, a finite number of alternative options, including use of neuroactive agents (SSRIs, SSNRs, and gabapentin), lifestyle changes, and nonprescription remedies such as phytoestrogens and black cohosh have been shown to provide relief, albeit with mixed results and questionable safety. Existing data identify an ethnic variation in the degree and frequency of VMS of aging; in this latter context, the Asian woman's perspective is dominantly conveyed from the perspective of Chinese and Japanese ethnicities, whereas data regarding the magnitude of burden of VMS in the postmenopausal women from other Asian ethnicities and races are sparse. This article reviews the symptoms and relates that VMS are of significant concern for the aging Asian women.

KEYWORDS

Hot flash - vasomotor symptoms - menopause - hormone therapy - phytoestrogens,

REFERENCES

  • 1 Freedman R R. Pathophysiology and treatment of menopausal hot flashes.  Semin Reprod Med. 2005;  23(2) 117-125
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Whiteman M K, Staropoli C A, Langenberg P W, McCarter R J, Kjerulff K H, Flaws J A. Smoking, body mass, and hot flashes in midlife women.  Obstet Gynecol. 2003;  101(2) 264-272
    CrossrefPubMedGoogle Scholar
  • 3 Gold E B, Sternfeld B, Kelsey J L et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age.  Am J Epidemiol. 2000;  152(5) 463-473
    CrossrefPubMedGoogle Scholar
  • 4 Ivarsson T, Spetz A C, Hammar M. Physical exercise and vasomotor symptoms in postmenopausal women.  Maturitas. 1998;  29(2) 139-146
    CrossrefPubMedGoogle Scholar
  • 5 Chakravarti S, Collins W P, Newton J R, Oram D H, Studd J W. Endocrine changes and symptomatology after oophorectomy in premenopausal women.  Br J Obstet Gynaecol. 1977;  84(10) 769-775
    PubMedGoogle Scholar
  • 6 Couzi R J, Helzlsouer K J, Fetting J H. Prevalence of menopausal symptoms among women with a history of breast cancer and attitudes toward estrogen replacement therapy.  J Clin Oncol. 1995;  13(11) 2737-2744
    PubMedGoogle Scholar
  • 7 Biglia N, Cozzarella M, Cacciari F et al. Menopause after breast cancer: a survey on breast cancer survivors.  Maturitas. 2003;  45(1) 29-38
    CrossrefPubMedGoogle Scholar
  • 8 Gold E B, Colvin A, Avis N et al. Longitudinal analysis of the association between vasomotor symptoms and race/ethnicity across the menopausal transition: Study of Women's Health across the Nation.  Am J Public Health. 2006;  96(7) 1226-1235
    CrossrefPubMedGoogle Scholar
  • 9 Gold E B, Block G, Crawford S et al. Lifestyle and demographic factors in relation to vasomotor symptoms: baseline results from the Study of Women's Health across the Nation.  Am J Epidemiol. 2004;  159(12) 1189-1199
    CrossrefPubMedGoogle Scholar
  • 10 Shah D, Agrawal S. A double-blind, randomized, placebo controlled trial to evaluate the efficacy of a phytoestrogen formulation on Indian women with menopausal symptoms.  Bombay Hosp J. 2006;  48(3) 449-454
    PubMedGoogle Scholar
  • 11 Syed Alwi S A, Lee P Y, Awi I, Mallik P S, Md Haizal M N. The menopausal experience among indigenous women of Sarawak, Malaysia.  Climacteric. 2009;  12(6) 548-556
    CrossrefPubMedGoogle Scholar
  • 12 Limpaphayom K K, Darmasetiawan M S, Hussain R I, Burriss S W, Holinka C F, Ausmanas M K. Differential prevalence of quality-of-life categories (domains) in Asian women and changes after therapy with three doses of conjugated estrogens/medroxyprogesterone acetate: the Pan-Asia Menopause (PAM) study.  Climacteric. 2006;  9(3) 204-214
    CrossrefPubMedGoogle Scholar
  • 13 Maclennan A H, Broadbent J L, Lester S, Moore V. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes.  Cochrane Database Syst Rev. 2004;  4 CD002978
    PubMedGoogle Scholar
  • 14 American College of Obstetricians and Gynecologists Women's Health Care Physicians . Executive summary. Hormone therapy.  Obstet Gynecol. 2004;  104(4, Suppl) 1S-4S
    CrossrefPubMedGoogle Scholar
  • 15 Utian W H, Archer D F, Bachmann G A North American Menopause Society et al. Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society.  Menopause. 2008;  15(4 Pt 1) 584-602
    CrossrefPubMedGoogle Scholar
  • 16 Utian W H, Shoupe D, Bachmann G, Pinkerton J V, Pickar J H. Relief of vasomotor symptoms and vaginal atrophy with lower doses of conjugated equine estrogens and medroxyprogesterone acetate.  Fertil Steril. 2001;  75(6) 1065-1079
    CrossrefPubMedGoogle Scholar
  • 17 Ettinger B. Vasomotor symptom relief versus unwanted effects: role of estrogen dosage.  Am J Med. 2005;  118(Suppl 12B) 74-78
    CrossrefPubMedGoogle Scholar
  • 18 Pasqualini J R. Progestins and breast cancer.  Gynecol Endocrinol. 2007;  23(Suppl 1) 32-41
    CrossrefPubMedGoogle Scholar
  • 19 Stovall D W, Pinkerton J V. Estrogen agonists/antagonists in combination with estrogen for prevention and treatment of menopause-associated signs and symptoms.  Womens Health (Lond Engl). 2008;  4(3) 257-268
    PubMedGoogle Scholar
  • 20 Grady D, Ettinger B, Tosteson A N, Pressman A, Macer J L. Predictors of difficulty when discontinuing postmenopausal hormone therapy.  Obstet Gynecol. 2003;  102(6) 1233-1239
    CrossrefPubMedGoogle Scholar
  • 21 Sestak I, Kealy R, Edwards R, Forbes J, Cuzick J. Influence of hormone replacement therapy on tamoxifen-induced vasomotor symptoms.  J Clin Oncol. 2006;  24(24) 3991-3996
    CrossrefPubMedGoogle Scholar
  • 22 Stovall D W, Utian W H, Gass M L et al. The effects of combined raloxifene and oral estrogen on vasomotor symptoms and endometrial safety.  Menopause. 2007;  14(3 Pt 1) 510-517
    CrossrefPubMedGoogle Scholar
  • 23 Pinkerton J V, Shifren J L, La Valleur J, Rosen A, Roesinger M, Siddhanti S. Influence of raloxifene on the efficacy of an estradiol-releasing ring for treating vaginal atrophy in postmenopausal women.  Menopause. 2003;  10(1) 45-52
    CrossrefPubMedGoogle Scholar
  • 24 Valiati B, Capp E, Edelweiss M I, de Freitas F M, Wender M C. Effect of raloxifene and low-dose percutaneous 17β-estradiol on menopause symptoms and endometrium—a randomized controlled trial.  Maturitas. 2009;  62(1) 81-84
    CrossrefPubMedGoogle Scholar
  • 25 Lewiecki E M. Bazedoxifene and bazedoxifene combined with conjugated estrogens for the management of postmenopausal osteoporosis.  Expert Opin Investig Drugs. 2007;  16(10) 1663-1672
    CrossrefPubMedGoogle Scholar
  • 26 Komm B S, Kharode Y P, Bodine P V, Harris H A, Miller C P, Lyttle C R. Bazedoxifene acetate: a selective estrogen receptor modulator with improved selectivity.  Endocrinology. 2005;  146(9) 3999-4008
    CrossrefPubMedGoogle Scholar
  • 27 Miller P D, Chines A A, Christiansen C et al.. Effects of bazedoxifene on BMD and bone turnover in postmenopausal women: 2-yr results of a randomized, double-blind, placebo-, and active-controlled study.  J Bone Miner Res. 2008;  23(4) 525-535
    CrossrefPubMedGoogle Scholar
  • 28 Pinkerton J V, Utian W H, Constantine G D, Olivier S, Pickar J H. Relief of vasomotor symptoms with the tissue-selective estrogen complex containing bazedoxifene/conjugated estrogens: a randomized, controlled trial.  Menopause. 2009;  16(6) 1116-1124
    CrossrefPubMedGoogle Scholar
  • 29 Stovall D W, Pinkerton J V. MF-101, an estrogen receptor β agonist for the treatment of vasomotor symptoms in peri- and postmenopausal women.  Curr Opin Investig Drugs. 2009;  10(4) 365-371
    PubMedGoogle Scholar
  • 30 Loprinzi C L, Sloan J, Stearns V et al. Newer antidepressants and gabapentin for hot flashes: an individual patient pooled analysis.  J Clin Oncol. 2009;  27(17) 2831-2837
    CrossrefPubMedGoogle Scholar
  • 31 Casper R F. Is paroxetine an effective treatment for hot flashes?.  Nat Clin Pract Endocrinol Metab. 2006;  2(5) 250-251
    CrossrefPubMedGoogle Scholar
  • 32 Pandya K J, Raubertas R F, Flynn P J et al. Oral clonidine in postmenopausal patients with breast cancer experiencing tamoxifen-induced hot flashes: a University of Rochester Cancer Center Community Clinical Oncology Program study.  Ann Intern Med. 2000;  132(10) 788-793
    PubMedGoogle Scholar
  • 33 Goldberg R M, Loprinzi C L, O'Fallon J R et al. Transdermal clonidine for ameliorating tamoxifen-induced hot flashes.  J Clin Oncol. 1994;  12(1) 155-158
    PubMedGoogle Scholar
  • 34 Laufer L R, Erlik Y, Meldrum D R, Judd H L. Effect of clonidine on hot flashes in postmenopausal women.  Obstet Gynecol. 1982;  60(5) 583-586
    PubMedGoogle Scholar
  • 35 Guttuso Jr T, Kurlan R, McDermott M P, Kieburtz K. Gabapentin's effects on hot flashes in postmenopausal women: a randomized controlled trial.  Obstet Gynecol. 2003;  101(2) 337-345
    CrossrefPubMedGoogle Scholar
  • 36 Pandya K J, Morrow G R, Roscoe J A et al. Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial.  Lancet. 2005;  366(9488) 818-824
    CrossrefPubMedGoogle Scholar
  • 37 North American Menopause Society . Treatment of menopause-associated vasomotor symptoms: position statement of The North American Menopause Society.  Menopause. 2004;  11(1) 11-33
    CrossrefPubMedGoogle Scholar
  • 38 Kuiper G G, Carlsson B, Grandien K et al. Comparison of the ligand binding specificity and transcript tissue distribution of estrogen receptors alpha and beta.  Endocrinology. 1997;  138(3) 863-870
    CrossrefPubMedGoogle Scholar
  • 39 Nagata C, Shimizu H, Takami R, Hayashi M, Takeda N, Yasuda K. Hot flushes and other menopausal symptoms in relation to soy product intake in Japanese women.  Climacteric. 1999;  2(1) 6-12
    CrossrefPubMedGoogle Scholar
  • 40 Van Patten C L, Olivotto I A, Chambers G K et al. Effect of soy phytoestrogens on hot flashes in postmenopausal women with breast cancer: a randomized, controlled clinical trial.  J Clin Oncol. 2002;  20(6) 1449-1455
    CrossrefPubMedGoogle Scholar
  • 41 Upmalis D H, Lobo R, Bradley L, Warren M, Cone F L, Lamia C A. Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study [published correction appears in Menopause 2000;7:422].  Menopause. 2000;  7(4) 236-242
    CrossrefPubMedGoogle Scholar
  • 42 Quella S K, Loprinzi C L, Barton D L et al. Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: A North Central Cancer Treatment Group Trial.  J Clin Oncol. 2000;  18(5) 1068-1074
    PubMedGoogle Scholar
  • 43 Albertazzi P, Pansini F, Bonaccorsi G, Zanotti L, Forini E, De Aloysio D. The effect of dietary soy supplementation on hot flushes [published correction appears in Obstet Gynecol 2001;98:702].  Obstet Gynecol. 1998;  91(1) 6-11
    CrossrefPubMedGoogle Scholar
  • 44 Han K K, Soares Jr J M, Haidar M A, de Lima G R, Baracat E C. Benefits of soy isoflavone therapeutic regimen on menopausal symptoms.  Obstet Gynecol. 2002;  99(3) 389-394
    CrossrefPubMedGoogle Scholar
  • 45 Krebs E E, Ensrud K E, MacDonald R, Wilt T J. Phytoestrogens for treatment of menopausal symptoms: a systematic review.  Obstet Gynecol. 2004;  104(4) 824-836
    CrossrefPubMedGoogle Scholar
  • 46 Lethaby A E, Brown J, Marjoribanks J, Kronenberg F, Roberts H, Eden J. Phytoestrogens for vasomotor menopausal symptoms.  Cochrane Database Syst Rev. 2007;  4(4) CD001395
    PubMedGoogle Scholar
  • 47 Low Dog T, Powell K L, Weisman S M. Critical evaluation of the safety of Cimicifuga racemosa in menopause symptom relief.  Menopause. 2003;  10(4) 299-313
    CrossrefPubMedGoogle Scholar
  • 48 Mahady G B. Is black cohosh estrogenic?.  Nutr Rev. 2003;  61(5 Pt 1) 183-186
    CrossrefPubMedGoogle Scholar
  • 49 Mahady G B. Black cohosh (Actaea/Cimicifuga racemosa): review of the clinical data for safety and efficacy in menopausal symptoms.  Treat Endocrinol. 2005;  4(3) 177-184
    CrossrefPubMedGoogle Scholar
  • 50 Huntley A, Ernst E. A systematic review of the safety of black cohosh.  Menopause. 2003;  10(1) 58-64
    CrossrefPubMedGoogle Scholar
  • 51 Borrelli F, Ernst E. Black cohosh (Cimicifuga racemosa): a systematic review of adverse events.  Am J Obstet Gynecol. 2008;  199(5) 455-466
    CrossrefPubMedGoogle Scholar
  • 52 Joy D, Joy J, Duane P. Black cohosh: a cause of abnormal postmenopausal liver function tests.  Climacteric. 2008;  11(1) 84-88
    CrossrefPubMedGoogle Scholar
  • 53 Hirata J D, Swiersz L M, Zell B, Small R, Ettinger B. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial.  Fertil Steril. 1997;  68(6) 981-986
    CrossrefPubMedGoogle Scholar
  • 54 Chenoy R, Hussain S, Tayob Y, O'Brien P M, Moss M Y, Morse P F. Effect of oral gamolenic acid from evening primrose oil on menopausal flushing.  BMJ. 1994;  308(6927) 501-503
    PubMedGoogle Scholar
  • 55 Wiklund I K, Mattsson L A, Lindgren R, Limoni C. Swedish Alternative Medicine Group . Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial.  Int J Clin Pharmacol Res. 1999;  19(3) 89-99
    PubMedGoogle Scholar
  • 56 Coon J T, Ernst E. Panax ginseng: a systematic review of adverse effects and drug interactions.  Drug Saf. 2002;  25(5) 323-344
    CrossrefPubMedGoogle Scholar
  • 57 Pittler M H, Ernst E. Efficacy of kava extract for treating anxiety: systematic review and meta-analysis.  J Clin Psychopharmacol. 2000;  20(1) 84-89
    CrossrefPubMedGoogle Scholar

Duru ShahM.D. F.R.C.O.G. F.C.P.S. F.I.C.S. F.I.C.O.G. F.I.C.M.C.H. D.G.O. D.F.P. 

Consultant, Breach Candy Hospital; Jaslok Hospital & Research Centre; Sir Hurkisondas Nurrotamdas Hospital & Research Centre; Chairman, The Indian College of Obstetricians & Gynecologists

Gynaecworld and Gynaecworld Assisted Fertility Unit Mumbai

Email: durushah@gmail.com

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