Vasomotor Symptoms: Clinical Management

  • Maria Celeste Osorio-WenderEmail author
  • Mona Lúcia Dall’Agno


Vasomotor symptoms (VMS) or “hot flashes” are the most common complaint during the menopausal transition. Despite they affect quality of life and appear to be linked to cardiovascular, bone, and brain health, only a minor seek medical attention for treatment.

The management of VMS is based on the symptom’s intensity and frequency and the women’s medical history and personal choice. There are several options for the treatment of hot flashes related to menopause, being the most effective the hormonal therapy. These data is supported by placebo-controlled trials.

For those postmenopausal women with medical contraindications to estrogen or personal preference not to use hormonal therapies, there are options with good results, including paroxetine, venlafaxine, desvenlafaxine, citalopram, escitalopram, and gabapentin.


Vasomotor symptoms Hot flashes Menopause Menopause management 


  1. 1.
    Thurston RC, Joffe H. Vasomotor symptoms and menopause: findings from the Study of Women’s Health across the Nation. Obstet Gynecol Clin N Am. 2011;38(3):489–501.CrossRefGoogle Scholar
  2. 2.
    Blümel JE, Chedraui P, Baron G, Belzares E, Bencosme A, Calle A, et al. A large multinational study of vasomotor symptom prevalence, duration, and impact on quality of life in middle-aged women. Menopause. 2011;18(7):778–85.CrossRefGoogle Scholar
  3. 3.
    Freedman RR. Menopausal hot flashes: mechanisms, endocrinology, treatment. J Steroid Biochem Mol Biol. 2014;142:115–20.CrossRefGoogle Scholar
  4. 4.
    The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017;24(7):728–53.CrossRefGoogle Scholar
  5. 5.
    Kravitz HM, Joffe H. Sleep during the perimenopause: a SWAN story. Obstet Gynecol Clin N Am. 2011;38(3):567–86.CrossRefGoogle Scholar
  6. 6.
    Avis NE, Crawford SL, Greendale G, Bromberger JT, Everson-Rose SA, Gold EB, et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med. 2015;175(4):531–9.CrossRefGoogle Scholar
  7. 7.
    ACOG Practice Bulletin No. 141: management of menopausal symptoms. Obstet Gynecol. 2014;123(1):202–16.Google Scholar
  8. 8.
    Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause. 2015;22(11):1155–72; quiz 73–4.Google Scholar
  9. 9.
    Hickey M, Szabo RA, Hunter MS. Non-hormonal treatments for menopausal symptoms. BMJ. 2017;359:j5101.CrossRefGoogle Scholar
  10. 10.
    Daley A, Stokes-Lampard H, Thomas A, MacArthur C. Exercise for vasomotor menopausal symptoms. Cochrane Database Syst Rev. 2014;(11):CD006108.Google Scholar
  11. 11.
    Cramer H, Peng W, Lauche R. Yoga for menopausal symptoms-a systematic review and meta-analysis. Maturitas. 2018;109:13–25.CrossRefGoogle Scholar
  12. 12.
    Mann E, Smith MJ, Hellier J, Balabanovic JA, Hamed H, Grunfeld EA, et al. Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial. Lancet Oncol. 2012;13(3):309–18.CrossRefGoogle Scholar
  13. 13.
    Ayers B, Smith M, Hellier J, Mann E, Hunter MS. Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial. Menopause. 2012;19(7):749–59.CrossRefGoogle Scholar
  14. 14.
    Goldstein KM, Shepherd-Banigan M, Coeytaux RR, McDuffie JR, Adam S, Befus D, et al. Use of mindfulness, meditation and relaxation to treat vasomotor symptoms. Climacteric. 2017;20(2):178–82.CrossRefGoogle Scholar
  15. 15.
    Saensak S, Vutyavanich T, Somboonporn W, Srisurapanont M. Relaxation for perimenopausal and postmenopausal symptoms. Cochrane Database Syst Rev. 2014;(7):CD008582.Google Scholar
  16. 16.
    Elkins GR, Fisher WI, Johnson AK, Carpenter JS, Keith TZ. Clinical hypnosis in the treatment of postmenopausal hot flashes: a randomized controlled trial. Menopause. 2013;20(3):291–8.PubMedGoogle Scholar
  17. 17.
    Barton DL, Loprinzi CL, Quella SK, Sloan JA, Veeder MH, Egner JR, et al. Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. J Clin Oncol. 1998;16(2):495–500.CrossRefGoogle Scholar
  18. 18.
    Bianchi MS, Ferreira CF, Fregni F, Schestatsky P, Caumo W, Wender MCO. Transcranial direct current stimulation effects on menopausal vasomotor symptoms. Menopause. 2017;24(10):1122–8.CrossRefGoogle Scholar
  19. 19.
    Lee MS, Shin BC, Ernst E. Acupuncture for treating menopausal hot flushes: a systematic review. Climacteric. 2009;12(1):16–25.CrossRefGoogle Scholar
  20. 20.
    Dodin S, Blanchet C, Marc I, Ernst E, Wu T, Vaillancourt C, et al. Acupuncture for menopausal hot flushes. Cochrane Database Syst Rev. 2013;(7):CD007410.Google Scholar
  21. 21.
    Ee C, French SD, Xue CC, Pirotta M, Teede H. Acupuncture for menopausal hot flashes: clinical evidence update and its relevance to decision making. Menopause. 2017;24(8):980–7.CrossRefGoogle Scholar
  22. 22.
    Taylor-Swanson L, Thomas A, Ismail R, Schnall JG, Cray L, Mitchell ES, et al. Effects of traditional Chinese medicine on symptom clusters during the menopausal transition. Climacteric. 2015;18(2):142–56.CrossRefGoogle Scholar
  23. 23.
    Befus D, Coeytaux RR, Goldstein KM, McDuffie JR, Shepherd-Banigan M, Goode AP, et al. Management of menopause symptoms with acupuncture: an umbrella systematic review and meta-analysis. J Altern Complement Med. 2018;24(4):314–23.CrossRefGoogle Scholar
  24. 24.
    Cobin RH, Goodman NF, Committee ARES. American association of clinical endocrinologists and American college of endocrinology position statement on menopause-2017 update. Endocr Pract. 2017;23(7):869–80.CrossRefGoogle Scholar
  25. 25.
    Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev. 2013;(12):CD001395.Google Scholar
  26. 26.
    Chen MN, Lin CC, Liu CF. Efficacy of phytoestrogens for menopausal symptoms: a meta-analysis and systematic review. Climacteric. 2015;18(2):260–9.CrossRefGoogle Scholar
  27. 27.
    Society NAM. The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Translational Science Symposium in Chicago, IL (October 2010). Menopause. 2011;18(7):732–53.CrossRefGoogle Scholar
  28. 28.
    Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012;(9):CD007244.Google Scholar
  29. 29.
    Baber RJ, Panay N, Fenton A, Group IW. 2016 IMS recommendations on women’s midlife health and menopause hormone therapy. Climacteric. 2016;19(2):109–50.CrossRefGoogle Scholar
  30. 30.
    Maclennan AH, Broadbent JL, Lester S, Moore V. Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev. 2004;(4):CD002978.Google Scholar
  31. 31.
    Komm BS, Mirkin S. Incorporating bazedoxifene/conjugated estrogens into the current paradigm of menopausal therapy. Int J Women’s Health. 2012;4:129–40.CrossRefGoogle Scholar
  32. 32.
    Lobo RA, Pinkerton JV, Gass ML, Dorin MH, Ronkin S, Pickar JH, et al. Evaluation of bazedoxifene/conjugated estrogens for the treatment of menopausal symptoms and effects on metabolic parameters and overall safety profile. Fertil Steril. 2009;92(3):1025–38.CrossRefGoogle Scholar
  33. 33.
    Cummings SR, Ettinger B, Delmas PD, Kenemans P, Stathopoulos V, Verweij P, et al. The effects of tibolone in older postmenopausal women. N Engl J Med. 2008;359(7):697–708.CrossRefGoogle Scholar
  34. 34.
    Serati M, Uccella S, Bolis P. Tibolone in older postmenopausal women. N Engl J Med. 2008;359(20):2173. author reply.PubMedGoogle Scholar
  35. 35.
    Nelson HD, Vesco KK, Haney E, Fu R, Nedrow A, Miller J, et al. Nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis. JAMA. 2006;295(17):2057–71.CrossRefGoogle Scholar
  36. 36.
    Rada G, Capurro D, Pantoja T, Corbalán J, Moreno G, Letelier LM, et al. Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst Rev. 2010;(9):CD004923.Google Scholar
  37. 37.
    Stearns V, Beebe KL, Iyengar M, Dube E. Paroxetine controlled release in the treatment of menopausal hot flashes: a randomized controlled trial. JAMA. 2003;289(21):2827–34.CrossRefGoogle Scholar
  38. 38.
    Stearns V, Slack R, Greep N, Henry-Tilman R, Osborne M, Bunnell C, et al. Paroxetine is an effective treatment for hot flashes: results from a prospective randomized clinical trial. J Clin Oncol. 2005;23(28):6919–30.CrossRefGoogle Scholar
  39. 39.
    Loprinzi CL, Kugler JW, Sloan JA, Mailliard JA, LaVasseur BI, Barton DL, et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet. 2000;356(9247):2059–63.CrossRefGoogle Scholar
  40. 40.
    Evans ML, Pritts E, Vittinghoff E, McClish K, Morgan KS, Jaffe RB. Management of postmenopausal hot flushes with venlafaxine hydrochloride: a randomized, controlled trial. Obstet Gynecol. 2005;105(1):161–6.CrossRefGoogle Scholar
  41. 41.
    Carpenter JS, Storniolo AM, Johns S, Monahan PO, Azzouz F, Elam JL, et al. Randomized, double-blind, placebo-controlled crossover trials of venlafaxine for hot flashes after breast cancer. Oncologist. 2007;12(1):124–35.CrossRefGoogle Scholar
  42. 42.
    Archer DF, Seidman L, Constantine GD, Pickar JH, Olivier S. A double-blind, randomly assigned, placebo-controlled study of desvenlafaxine efficacy and safety for the treatment of vasomotor symptoms associated with menopause. Am J Obstet Gynecol. 2009;200(2):172.e1–10.CrossRefGoogle Scholar
  43. 43.
    Bouchard P, Panay N, de Villiers TJ, Vincendon P, Bao W, Cheng RJ, et al. Randomized placebo- and active-controlled study of desvenlafaxine for menopausal vasomotor symptoms. Climacteric. 2012;15(1):12–20.CrossRefGoogle Scholar
  44. 44.
    Pinkerton JV, Constantine G, Hwang E, Cheng RF, Investigators S. Desvenlafaxine compared with placebo for treatment of menopausal vasomotor symptoms: a 12-week, multicenter, parallel-group, randomized, double-blind, placebo-controlled efficacy trial. Menopause. 2013;20(1):28–37.CrossRefGoogle Scholar
  45. 45.
    Pinkerton JV, Archer DF, Guico-Pabia CJ, Hwang E, Cheng RF. Maintenance of the efficacy of desvenlafaxine in menopausal vasomotor symptoms: a 1-year randomized controlled trial. Menopause. 2013;20(1):38–46.CrossRefGoogle Scholar
  46. 46.
    Barton DL, LaVasseur BI, Sloan JA, Stawis AN, Flynn KA, Dyar M, et al. Phase III, placebo-controlled trial of three doses of citalopram for the treatment of hot flashes: NCCTG trial N05C9. J Clin Oncol. 2010;28(20):3278–83.CrossRefGoogle Scholar
  47. 47.
    Freeman EW, Guthrie KA, Caan B, Sternfeld B, Cohen LS, Joffe H, et al. Efficacy of escitalopram for hot flashes in healthy menopausal women: a randomized controlled trial. JAMA. 2011;305(3):267–74.CrossRefGoogle Scholar
  48. 48.
    Freedman RR, Kruger ML, Tancer ME. Escitalopram treatment of menopausal hot flashes. Menopause. 2011;18(8):893–6.CrossRefGoogle Scholar
  49. 49.
    Loprinzi CL, Sloan JA, Perez EA, Quella SK, Stella PJ, Mailliard JA, et al. Phase III evaluation of fluoxetine for treatment of hot flashes. J Clin Oncol. 2002;20(6):1578–83.CrossRefGoogle Scholar
  50. 50.
    Suvanto-Luukkonen E, Koivunen R, Sundström H, Bloigu R, Karjalainen E, Häivä-Mällinen L, et al. Citalopram and fluoxetine in the treatment of postmenopausal symptoms: a prospective, randomized, 9-month, placebo-controlled, double-blind study. Menopause. 2005;12(1):18–26.CrossRefGoogle Scholar
  51. 51.
    Kimmick GG, Lovato J, McQuellon R, Robinson E, Muss HB. Randomized, double-blind, placebo-controlled, crossover study of sertraline (Zoloft) for the treatment of hot flashes in women with early stage breast cancer taking tamoxifen. Breast J. 2006;12(2):114–22.CrossRefGoogle Scholar
  52. 52.
    Gordon PR, Kerwin JP, Boesen KG, Senf J. Sertraline to treat hot flashes: a randomized controlled, double-blind, crossover trial in a general population. Menopause. 2006;13(4):568–75.CrossRefGoogle Scholar
  53. 53.
    Grady D, Cohen B, Tice J, Kristof M, Olyaie A, Sawaya GF. Ineffectiveness of sertraline for treatment of menopausal hot flushes: a randomized controlled trial. Obstet Gynecol. 2007;109(4):823–30.CrossRefGoogle Scholar
  54. 54.
    Desmarais JE, Looper KJ. Interactions between tamoxifen and antidepressants via cytochrome P450 2D6. J Clin Psychiatry. 2009;70(12):1688–97.CrossRefGoogle Scholar
  55. 55.
    Brown JN, Wright BR. Use of gabapentin in patients experiencing hot flashes. Pharmacotherapy. 2009;29(1):74–81.CrossRefGoogle Scholar
  56. 56.
    Pandya KJ, Morrow GR, Roscoe JA, Zhao H, Hickok JT, Pajon E, et al. Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial. Lancet. 2005;366(9488):818–24.CrossRefGoogle Scholar
  57. 57.
    Hayes LP, Carroll DG, Kelley KW. Use of gabapentin for the management of natural or surgical menopausal hot flashes. Ann Pharmacother. 2011;45(3):388–94.CrossRefGoogle Scholar
  58. 58.
    Bordeleau L, Pritchard KI, Loprinzi CL, Ennis M, Jugovic O, Warr D, et al. Multicenter, randomized, cross-over clinical trial of venlafaxine versus gabapentin for the management of hot flashes in breast cancer survivors. J Clin Oncol. 2010;28(35):5147–52.CrossRefGoogle Scholar
  59. 59.
    Loprinzi CL, Qin R, Balcueva EP, Baclueva EP, Flynn KA, Rowland KM, et al. Phase III, randomized, double-blind, placebo-controlled evaluation of pregabalin for alleviating hot flashes, N07C1. J Clin Oncol. 2010;28(4):641–7.CrossRefGoogle Scholar
  60. 60.
    Borba CM, Ferreira CF, Ferreira FV, Bianchi MS, Dall’Agno ML, Pérez-Lopez FR, et al. Sulpiride attenuates hot flashes: initial results from a randomized, double-blind clinical trial. 2019 (In preparation).Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Maria Celeste Osorio-Wender
    • 1
    Email author
  • Mona Lúcia Dall’Agno
    • 1
  1. 1.Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia, Grupo de Pesquisa Climatério e Menopausa, Serviço de Ginecologia e ObstetríciaHospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do SulPorto AlegreBrazil

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