Department of Medicine, University of Minnesota, Minneapolis, MN.
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.
Menopause. 2020 Oct;27(10):1126-1136. doi: 10.1097/GME.0000000000001597.
The Menopause Strategies: Finding Lasting Answers for Symptoms and Health network conducted three randomized clinical trials (RCTs) testing six interventions treating vasomotor symptoms (VMS), and also collected menopause-related quality of life (QOL) measures. A fourth RCT assessed an intervention for insomnia symptoms among women with VMS. We describe these seven interventions' effects on menopause-related QOL relative to control in women with VMS.
We pooled individual-level data from 1,005 peri- and postmenopausal women with 14 or more VMS/week across the four RCTs. Interventions included escitalopram 10 to 20 mg/d; yoga/aerobic exercise; 1.8 g/d omega-3-fatty acids; oral 17-beta-estradiol 0.5 mg/d; venlafaxine XR 75 mg/d; and cognitive behavioral therapy for insomnia (CBT-I). Outcomes measures were the Menopause-specific Quality of Life scale and its subscales.
Significant improvements in total Menopause-specific Quality of Life from baseline were observed with estradiol, escitalopram, CBT-I, and yoga, with mean decreases of 0.3 to 0.5 points relative to control. The largest improvement in the vasomotor subscale was observed with estradiol (-1.2 points), with more modest but significant effects seen with escitalopram, yoga, and CBT-I. Significant improvements in the psychosocial subscale were observed for escitalopram, venlafaxine, and CBT-I. For the physical subscale, the greatest improvement was observed for CBT-I and exercise, whereas for the sexual subscale, the greatest improvement was observed for CBT-I, with yoga and estradiol demonstrating smaller effects.
These results suggest that for menopause-related QOL, women have a variety of treatment strategies to choose from and can select an approach based on most bothersome symptoms and individual preferences.
绝经策略：寻找症状和健康网络的持久答案进行了三项随机临床试验 (RCT)，测试了六种治疗血管舒缩症状 (VMS) 的干预措施，还收集了与绝经相关的生活质量 (QOL) 措施。第四项 RCT 评估了 VMS 女性失眠症状的干预措施。我们描述了这七种干预措施相对于 VMS 女性的对照治疗对与绝经相关的 QOL 的影响。
我们从四项 RCT 中的 1005 名绝经前后有 14 次或更多 VMS/周的女性中汇总了个体水平的数据。干预措施包括艾司西酞普兰 10 至 20 毫克/天；瑜伽/有氧运动；1.8 克/天 ω-3 脂肪酸；口服 17-β-雌二醇 0.5 毫克/天；文拉法辛 XR 75 毫克/天；以及失眠的认知行为疗法 (CBT-I)。结局测量指标为绝经特异性生活质量量表及其子量表。
与对照组相比，观察到雌二醇、艾司西酞普兰、CBT-I 和瑜伽治疗的绝经特异性生活质量总评分从基线开始显著改善，平均降低 0.3 至 0.5 分。观察到雌二醇对血管舒缩子量表的改善最大（-1.2 点），而艾司西酞普兰、瑜伽和 CBT-I 则显示出更适度但显著的效果。艾司西酞普兰、文拉法辛和 CBT-I 对心理社会子量表的改善显著。对于身体子量表，最大的改善是 CBT-I 和运动，而对于性子量表，最大的改善是 CBT-I，瑜伽和雌二醇的效果较小。
这些结果表明，对于与绝经相关的 QOL，女性有多种治疗策略可供选择，可以根据最困扰的症状和个人偏好选择一种方法。
