Umland Elena M
Jefferson College of Pharmacy, Thomas Jefferson University, 130 South 9th St., Philadelphia, PA 19107, USA.
J Manag Care Pharm. 2008 Apr;14(3 Suppl):14-9. doi: 10.18553/jmcp.2008.14.S6-A.14.
Vasomotor symptoms (VMS), such as hot flashes and night sweats, are the most bothersome symptoms of menopause and affect an estimated 75% of women aged over 50 years.
To discuss the burden, pathophysiology, and management of menopause-associated VMS and to evaluate pharmacologic options available for the treatment of VMS, including herbal remedies, hormone replacement therapy (HRT), and nonhormonal therapies.
Lifestyle changes, including regulation of core body temperature, relaxation techniques, regular physical activity, weight loss, and smoking cessation may help reduce the risk of VMS and should be implemented by all women with menopause-associated VMS. The role of herbal remedies in the treatment of VMS remains unclear, as clinical trial efficacy data are inconsistent and inconclusive. Nevertheless, soy isoflavones, red clover isoflavones, black cohosh, and vitamin E are commonly used to treat VMS and may be considered in women with mild symptoms that are not controlled by lifestyle changes alone. These herbal remedies appear to be safe when used for short durations (d 6 months). HRT, consisting of estrogen (in women without a uterus) or estrogen plus progestin (in women with a uterus) is the most widely studied and most effective treatment option for relief of menopause-associated VMS and is considered the standard of care for women with moderate-to-severe VMS. HRT should be used at the lowest effective dose and for the shortest duration possible (preferably d 5 years) in women in whom the potential benefits outweigh the potential risks. Nonhormonal therapies, such as selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, gabapentin, and clonidine, may be appropriate alternatives in women who cannot or will not use HRT for VMS relief, such as those with a history of or at risk for breast cancer.
The physical and financial burden imposed by menopauseassociated VMS is immense. Optimum management of VMS includes lifestyle changes in all women and HRT in women with moderate-tosevere symptoms. Less effective herbal remedies or nonhormonal therapies may be appropriate in certain women, such as those with mild symptoms or those who cannot or will not take HRT.
血管舒缩症状（VMS），如潮热和盗汗，是绝经最困扰人的症状，估计影响75%的50岁以上女性。
探讨绝经相关VMS的负担、病理生理学及管理，并评估可用于治疗VMS的药物选择，包括草药疗法、激素替代疗法（HRT）和非激素疗法。
生活方式改变，包括调节核心体温、放松技巧、规律体育活动、体重减轻和戒烟，可能有助于降低VMS风险，所有有绝经相关VMS的女性都应采用。草药疗法在治疗VMS中的作用仍不明确，因为临床试验疗效数据不一致且无定论。然而，大豆异黄酮、红三叶草异黄酮、黑升麻和维生素E常用于治疗VMS，对于仅通过生活方式改变无法控制轻度症状的女性可考虑使用。这些草药疗法短期使用（≤6个月）似乎是安全的。HRT，即单独使用雌激素（子宫已切除的女性）或雌激素加孕激素（子宫未切除的女性），是缓解绝经相关VMS研究最广泛且最有效的治疗选择，被认为是中重度VMS女性的标准治疗。对于潜在益处大于潜在风险的女性，HRT应使用最低有效剂量并尽可能短疗程（最好≤5年）。非激素疗法，如选择性5-羟色胺再摄取抑制剂、5-羟色胺-去甲肾上腺素再摄取抑制剂、加巴喷丁和可乐定，对于因VMS缓解而不能或不愿使用HRT的女性，如患有乳腺癌病史或有乳腺癌风险的女性，可能是合适的替代选择。
绝经相关VMS带来的身体和经济负担巨大。VMS的最佳管理包括所有女性的生活方式改变以及中重度症状女性的HRT。效果较差的草药疗法或非激素疗法在某些女性中可能合适，如症状较轻或不能或不愿接受HRT的女性。
