Sarri, G., Pedder, H., Dias, S., Guo, Y. and Lumsden, M. A. (2017) Vasomotor symptoms resulting from natural menopause: a systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause. BJOG: An International Journal of Obstetrics and Gynaecology, 124(10), pp. 1514-1523. (doi: 10.1111/1471-0528.14619) (PMID:28276200)
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Abstract
Background: Vasomotor symptoms (VMS) are the hallmarks of menopause, occurring in approximately 75% of postmenopausal women in the UK and are severe in 25%. Objectives: To identify which treatments are most clinically effective for the relief of VMS for non-hysterectomized women in natural menopause. Search Strategy: English publications in MEDLINE, Embase and The Cochrane Library up to 13th January 2015 were searched. Selection Criteria: Randomized trials (RCTs) of treatments for women with a uterus for the outcomes of frequency of VMS (up to 26 weeks), vaginal bleeding and discontinuation. Data Collection and Analysis: Bayesian network meta-analysis (NMA) using mean ratios (MRs) and odd ratios (ORs). Main Results: Across the three networks, 47 RCTs of 16 treatment classes (N=8326 women) were included. When compared to placebo, transdermal oestradiol and progestogen (O+P) had the highest probability of being the most effective treatment for VMS relief (69.8%) (MR: 0.23 [95%CrI (0.09, 0.57)] whereas oral O+P was ranked lower than transdermal O+P, although oral and transdermal O+P were no different for this outcome (MR: 2.23 [95%CrI (0.7, 7.1)]. Isoflavones and black cohosh were more effective than placebo, though not significantly better than O+P. Not only were SSRIs or SNRIs found ineffective in relieving VMS but they also had significantly higher odds of discontinuation than placebo. Limited data were available for bleeding therefore no conclusions could be made. Conclusions: For non-hysterectomized women, transdermal O+P was the most effective treatment for VMS relief.
| Item Type: | Articles |
|---|---|
| Keywords: | Hormonal treatment, menopause, network meta-analysis, uterus. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Lumsden, Professor Mary |
| Authors: | Sarri, G., Pedder, H., Dias, S., Guo, Y., and Lumsden, M. A. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | BJOG: An International Journal of Obstetrics and Gynaecology |
| Publisher: | Wiley |
| ISSN: | 1470-0328 |
| ISSN (Online): | 1471-0528 |
| Published Online: | 09 March 2017 |
| Copyright Holders: | Copyright © 2017 Royal College of Obstetricians and Gynaecologists |
| First Published: | First published in BJOG: An International Journal of Obstetrics and Gynaecology 124(10): 1514-1523 |
| Publisher Policy: | Reproduced in accordance with the publisher copyright policy |
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