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. 

In This Article

Other Treatments

Acupuncture

Acupuncture is a traditional component of Chinese medicine in which thin needles are inserted into the skin at key points in the body to balance the flow of energy or chi. Sham acupuncture is a placebo treatment involving needles inserted at unrelated points on the body or use of special needles that do not pierce the skin.

Drawing on a sizeable body of clinical trials, most systematic reviews,[140,141] and a 2013 Cochrane review[142] conclude that, although acupuncture is superior to no treatment or a wait-list control,[143,144,145,146,147] acupuncture is not superior to sham acupuncture.[148,149,150,151,152,153,154]A 2015 review and meta-analysis concluded that acupuncture is effective in reducing VMS frequency and severity as well as in improving quality of life and psychiatric, somatic, and urogenital aspects of the Menopause Rating Scale.[155] However, the 2015 meta-analysis combined trials comparing acupuncture to sham acupuncture with trials comparing acupuncture to wait-list controls and also included a 2014 trial in which the effect size for reduction in VMS frequency was the largest among all studies comparing acupuncture to sham control.[114]

Most trials comparing acupuncture to sham acupuncture find no significant difference in VMS frequency or severity between the two treatments, whereas most trials using a waitlist control find that acupuncture reduces VMS frequency and severity. There is considerable debate about what the appropriate control group should be in studies of acupuncture. Some[155] have suggested that the light touch of the skin during sham acupuncture might induce a ‘‘limbic touch response’’ that can induce release of beta endorphins, a mechanism that has been implicated in VMS.[156] Generally, however, needling at acupuncture points does not appear to reduce VMS frequency or intensity independently of the superficial touch of a sham needle.

Acupuncture cannot be recommended for the treatment of VMS. Level I evidence

Stellate Ganglion Block

Emerging evidence suggests that stellate ganglion blockade (SGB), a widely used anesthesia treatment for pain management, is a promising treatment for VMS, but larger trials are needed. The stellate ganglion is a bilateral neural structure located in the C6-T2 region of the anterior cervical spine and can be safely blocked via the image-guided injection of local anesthetic (eg, bupivacaine) at the C6 level. The exact mechanism of action of SGB on VMS is unclear. Adverse events, such as transient seizures or a bleeding complication, occur extremely rarely.[157] The adverse events include pain with injection and transient bruising at the injection site. Four uncontrolled, open-label studies showed that SGB reduced VMS, with effects ranging from a 45% to 90% reduction 6 weeks to several months after blockade.[158,159,160,161] There has been one randomized, sham-controlled trial of active SGB with bupivacaine versus a sham procedure involving subcutaneous saline injection in women with natural or surgical menopause (n=40).[162] Over a 6-month follow-up, there was no significant effect of SGB on overall VMS frequency. However, frequency of moderate to very severe subjective VMS and intensity of VMS was significantly reduced among SGB-treated women compared with the sham-control group. The frequency of physiologic VMS, measured with ambulatory skin conductance monitors, was reduced by 21% from baseline to 3 months in the SGB group, whereas the sham-control group showed no reduction. None of the study participants experienced adverse events.

Findings suggest that SGB might be an effective nonhormonal treatment for moderate to very severe VMS, but larger studies are needed. Level II evidence

Calibration of Neural Oscillations

In an uncontrolled study, 14 women showed a significant reduction in VMS frequency and severity after administration of an intervention aimed at autocalibration of neural oscillations. [163]The technique, called high-resolution, relational, resonance-based electroencephalic mirroring (HIRREM), aims to reduce VMS-related increases in amplitudes in high-frequency brain electrical activity. HIRREM is not recommended for treatment for VMS because of the lack of controlled trials. Level III evidence

Chiropractic Intervention

To date, there have been no clinical trials of chiropractic interventions for VMS, and available studies from epidemiologic survey data show no association between use of such interventions and VMS.[164] Chiropractic interventions are not recommended for treatment of VMS. Level III evidence

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