Transdermal Estrogen and Progestogen Most Effective to Reduce Menopausal Vasomotor Symptoms


Am Fam Physician. 2017 Dec 1;96(11):744.

Clinical Question

Which treatments are most effective for the relief of vasomotor symptoms among naturally menopausal women?

Bottom Line

Transdermal estrogen plus progestogen, or oral estrogen plus progestogen, is the treatment most likely to effectively reduce the frequency of vasomotor symptoms among menopausal women. Isoflavones and black cohosh were found to be better than placebo. Other treatments, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are not likely to be beneficial and are more likely to be discontinued than placebo. (Level of Evidence = 1a–)


This meta-analysis of 47 randomized controlled trials (RCTs) was conducted on behalf of the U.K. National Institute of Health and Care Excellence for the purpose of clinical guideline development. The authors used a technique called network meta-analysis, which is suitable for decision making when multiple treatments are being considered for one indication, and the treatments have not been directly compared in the same trials. In this case, the question considered was the effectiveness of pharmacologic and nonpharmacologic treatment for vasomotor symptoms among naturally menopausal women (defined as amenorrhea for at least 12 consecutive months). Trials of nonpharmacologic treatments had to be of at least four weeks duration, and trials to assess pharmacologic treatment had to be of at least 12 weeks duration. The authors considered 26 weeks to be the maximum follow-up time.

There were 32 RCTs of 12 treatment classes that assessed the frequency of vasomotor symptoms at the end of treatment, the principal end point considered. Combination treatment with transdermal estrogen and progestogen (E+P) had the highest probability (69%) of being the most effective treatment. The combination of oral E+P had a point estimate suggesting it was similarly effective to transdermal E+P, but with a wide confidence interval. There was strong evidence that

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



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Dec 15, 2018

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