Departamento de Endocrinología, Pontificia Universidad Católica de Chile, Endocrinología, Lira 85, Santiago, Chile.
Climacteric. 2012 Apr;15(2):115-24. doi: 10.3109/13697137.2011.624214. Epub 2011 Dec 8.
Non-hormonal treatment for menopausal vasomotor symptoms (VMS) is needed in women in whom there are medical or personal concerns on the use of hormone therapy. This paper reviews conventional and phytochemical therapies available for the relief of VMS, on their mechanisms of action, their efficacy and safety concerns.
Medline was searched through Pubmed on the names of the diverse therapies analyzed, up to June 2011. The Cochrane Controlled Clinical Trials Register Database was searched for relevant trials that provided data on treatment of menopausal hot flushes.
All non-estrogen treatments for VMS are less efficacious than estrogen treatment. Randomized trials with neuroendocrine agents show globally modest to moderate reduction of VMS and frequent bothersome adverse events. The variability of effects makes it possible to undergo treatment in search for individual response where estrogen treatment is contraindicated. The antidepressants that interact with cytochrome P450, inhibiting tamoxifen metabolism to endoxifen, interfere with tamoxifen therapy in breast cancer patients. Otherwise, botanical products containing isoflavones from soy bean or red clover have great variability in bioavailability, have a broader spectrum of action than estradiol, and have predominant estrogen receptor-b activity. The efficacy of phytoestrogens on VMS is similar to placebo. They should be avoided in women with breast cancer and, in particular, in women being treated with tamoxifen or aromatase inhibitors due to possible antagonism. Cimicifuga racemosa is not a phytoestrogen, has partial serotonin agonist action and has a modest effect on VMS.
There are safe non-hormonal conventional treatments for menopausal VMS, although they are less efficacious than estrogens. The indication of phytochemicals is for women who make this choice on personal beliefs; long-term studies of larger groups of patients are needed to assess safety.
对于因医学或个人原因不能使用激素治疗的绝经期血管舒缩症状（VMS）患者，需要非激素治疗。本文综述了缓解 VMS 的常规和植物化学疗法，包括其作用机制、疗效和安全性。
通过 Pubmed 在 Medline 上搜索分析的各种疗法的名称，检索时间截至 2011 年 6 月。在 Cochrane 对照临床试验注册数据库中检索了关于治疗绝经期热潮红的相关试验。
所有非雌激素治疗 VMS 的疗效均不如雌激素治疗。随机试验显示，神经内分泌药物对 VMS 的总体疗效为轻度至中度，且不良反应频繁且令人困扰。由于个体反应的可能性，使治疗效果存在变异性，在雌激素治疗禁忌的情况下，可以进行治疗。与细胞色素 P450 相互作用的抗抑郁药抑制他莫昔芬代谢为 Endoxifen，会干扰乳腺癌患者的他莫昔芬治疗。其他含有大豆或红三叶草异黄酮的植物产品，生物利用度差异很大，作用谱比雌二醇更广，且主要具有雌激素受体-β 活性。植物雌激素对 VMS 的疗效与安慰剂相似。由于可能存在拮抗作用，这些药物应避免用于患有乳腺癌的女性，尤其是正在接受他莫昔芬或芳香酶抑制剂治疗的女性。升麻是一种非植物雌激素，具有部分 5-羟色胺激动剂作用，对 VMS 有适度疗效。
对于绝经期 VMS，有安全的非激素常规治疗方法，但疗效不如雌激素。植物化学物质的适应证是那些基于个人信念选择这种治疗方法的女性；需要对更大患者群体进行长期研究，以评估安全性。
