Nonhormonal Management of Menopause-associated Vasomotor Symptoms: 2015 Position Statement of The North American Menopause Society

The North American Menopause Society (NAMS). 2015;22(11):1155-1174. 

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For this position statement, an experienced reference librarian searched five multidisciplinary databases using appropriate keywords. The types of nonhormonal therapies included in the search were identified from the previous position statement as well as review articles. (For examples, see reviews by Nedrow and colleagues[9] and Nelson and colleagues.[10]) The databases searched were Academic Search Premier, Embase, Family and Society Studies Worldwide, PsychInfo, and PubMed. These databases were identified for searching on the basis of their medical, psychological, and sociological content, which were all pertinent to the subject. The searches were split into three sections to differentiate the results for easier review: pharmaceuticals,supplements, and nonprescription and nonsupplemental therapies.

After searching each treatment type, 2,919 results were returned from all five databases. After removing articles not in English, duplicate articles across databases, and consumer publications, 1,428 citations remained. Articles including men, hormonal therapy, or narrative reviews were eliminated. Further review by the position statement panel distilled the results for review to 340 original research articles and 105 systematic reviews. Of these, 83% of the research articles and 88% of the systematic reviews were published between 2005 and 2015, or after the previous NAMS position statement was published, illustrating the growth in the literature that needed to be incorporated into this new position statement.

Individual panel members reviewed the evidence on the different therapies for which they had special expertise and made treatment recommendations. Members evaluated the evidence for various nonhormonal therapies with the knowledge that nonhormonal VMS trials have a placebo improvement rate of 20% to 60%, with more anxious women showing higher response to placebo.[11]

Levels of evidence were assigned on the basis of the following categories: Level I—high-quality randomized trials; systematic reviews of level I studies. Level II— lesser-quality randomized, controlled trials (RCTs), systematic reviews of level II studies, or level I studies with inconsistent results. We included trials using poorly validated measures (eg, Kupperman Index) in this category. Level III— uncontrolled trials, case-control studies, systematic reviews of level III studies. Level IV—case series, case-control studies. Level V—expert opinion. Citations refer primarily to RCTs and higher-quality reviews (eg, meta-analyses, Cochrane reviews), with no attempts made to cite all available reviews.