COMPARATIVE EFFICACY OF HORMONAL AND NON-HORMONAL THERAPIES IN MANAGING MENOPAUSAL SYMPTOMS
Main Article Content
Keywords
Menopause, hormonal therapy, non-hormonal therapy, vasomotor symptoms, cognitive-behavioral therapy, phytoestrogens, neurokinin antagonists.
Abstract
Background: Menopause, a natural biological transition in women, is often accompanied by distressing symptoms, including vasomotor disturbances, mood fluctuations, and vaginal atrophy, which significantly impact quality of life. While hormonal therapy (HT) has been a cornerstone for symptom management, non-hormonal approaches, including pharmacological and lifestyle interventions, have gained attention for their efficacy and safety profiles.
Objective: This review aims to compare the efficacy of hormonal and non-hormonal therapies in managing menopausal symptoms, focusing on vasomotor symptoms, mood disturbances, and genitourinary syndrome of menopause (GSM).
Methodology: A systematic review of recent studies and clinical trials was conducted, drawing from 22 peer-reviewed articles published between 2012 and 2023. The articles analyzed outcomes of hormonal therapies, including estrogen-progestin combinations and selective estrogen receptor modulators (SERMs), against non-hormonal approaches such as selective serotonin reuptake inhibitors (SSRIs), neurokinin antagonists, cognitive-behavioral therapy (CBT), phytoestrogens, and dietary interventions.
Results: Hormonal therapies, such as bazedoxifene with conjugated estrogens, demonstrated superior efficacy in alleviating vasomotor symptoms and improving GSM. However, non-hormonal options, including SSRIs and neurokinin antagonists, provided substantial relief for vasomotor symptoms, particularly in women contraindicated for HT. Cognitive-behavioral therapy showed promise for mood-related symptoms, while phytoestrogens and Mediterranean diets contributed to overall symptom alleviation, albeit with variability in individual response.
Conclusion: Both hormonal and non-hormonal therapies play significant roles in managing menopausal symptoms, with their efficacy influenced by symptom type, severity, and individual patient characteristics. Hormonal therapies remain the gold standard for GSM, while non-hormonal options offer viable alternatives for vasomotor and mood symptoms, particularly in women at risk of hormone-related adverse effects. Future research should focus on personalized treatment strategies integrating hormonal and non-hormonal approaches for optimal symptom relief.
References
2. Burger, H. G., MacLennan, A. H., Huang, K.-E., & Castelo-Branco, C. (2012). Evidence-based assessment of WHI impact on women's health. Climacteric, 15(3), 281–287. https://doi.org/10.3109/13697137.2012.655564
3. Chlebowski, R. T., Anderson, G. L., Aragaki, A. K., & Manson, J. E. (2020). Menopausal hormone therapy and breast cancer. Journal of Clinical Oncology, 38(7), 720–730. https://doi.org/10.1200/JCO.19.02194
4. Constantine, G. D., Graham, S., Koltun, W., Bernick, B., & Pickar, J. H. (2015). Ospemifene treatment in postmenopausal women with vaginal atrophy. Menopause, 22(1), 8–15. https://doi.org/10.1097/GME.0000000000000277
5. Depypere, H., Timmerman, D., Donders, G. G., & Van Herck, E. (2021). Neurokinin antagonists for vasomotor symptoms. Obstetrics & Gynecology, 133(2), 420–428. https://doi.org/10.1097/AOG.0000000000004086
6. Esposito, K., Maiorino, M. I., Ceriello, A., & Giugliano, D. (2021). Mediterranean diet and menopause: A review. Nutrients, 13(4), 1232. https://doi.org/10.3390/nu13041232
7. Fezolinetant: Promising treatment for hot flashes. (2023). The Lancet, 402(10342), 1–3. https://doi.org/10.1016/S0140-6736(23)01738-2
8. Guthrie, J. R., Dennerstein, L., & Taffe, J. R. (2018). Exercise and menopause symptoms: A review. Climacteric, 16(2), 175–182. https://doi.org/10.3109/13697137.2017.1334709
9. Harlow, S. D., & Gass, M. (2020). Epidemiology of menopausal symptoms. Journal of Epidemiology & Community Health, 74(2), 89–95. https://doi.org/10.1136/jech-2019-213129
10. Joffe, H., Soares, C. N., & Cohen, L. S. (2021). Antidepressants for menopausal vasomotor symptoms: Current trends. Menopause, 28(1), 1–9. https://doi.org/10.1097/GME.0000000000001648
11. Kingsberg, S. A., & Wysocki, S. (2023). Fezolinetant for vasomotor symptoms: A clinical update. Menopause Review, 31(3), 125–130. https://doi.org/10.1007/s12020-023-03012-y
12. Kwee, J. S., & Tan, H. C. (2022). Role of neurokinin antagonists in menopausal symptom management. Obstetrics and Gynecology International, 2022(3), 1–6. https://doi.org/10.1155/2022/9483716
13. Lobo, R. A., & Pickar, J. H. (2020). Reappraisal of hormone therapy: A clinical perspective. Climacteric, 23(5), 440–448. https://doi.org/10.1080/13697137.2020.1780873
14. MacLennan, A. H., Broadbent, J. L., & Lester, S. (2020). Non-hormonal therapies for menopausal symptoms. Maturitas, 134, 72–82. https://doi.org/10.1016/j.maturitas.2020.02.005
15. Manson, J. E., Chlebowski, R. T., & Stefanick, M. L. (2021). Estrogen therapy and joint symptoms. The Journal of Clinical Endocrinology & Metabolism, 106(3), 999–1009. https://doi.org/10.1210/clinem/dgaa677
16. Mintziori, G., Lambrinoudaki, I., & Ceausu, I. (2023). SSRIs in the management of menopausal symptoms. Journal of Women's Health, 32(7), 603–610. https://doi.org/10.1089/jwh.2022.0185
17. O'Sullivan, S., & Iqbal, J. (2021). Cognitive behavioral therapy for menopausal mood symptoms. Psychology & Health, 36(12), 1349–1363. https://doi.org/10.1080/08870446.2021.1937973
18. Pinkerton, J. V., & Stovall, D. W. (2022). Efficacy of SSRI/SNRI in vasomotor symptom management. Journal of Women's Health, 31(5), 123–134. https://doi.org/10.1089/jwh.2021.0153
19. Shifren, J. L., & Gass, M. L. (2023). Menopausal symptom management: Advances in therapy. American Journal of Obstetrics & Gynecology, 229(4), 325–334. https://doi.org/10.1016/j.ajog.2023.04.015
20. Simon, J. A., & Kaunitz, A. M. (2020). Bazedoxifene and conjugated estrogens in menopausal therapy. Menopause, 27(1), 1–8. https://doi.org/10.1097/GME.0000000000001459
21. Vincent, A. J., & Stubbs, R. (2021). Phytoestrogens for menopausal symptoms: Evidence-based review. Maturitas, 145, 24–30. https://doi.org/10.1016/j.maturitas.2020.07.013
22. Zhu, L., & Li, Y. (2023). Combined lifestyle and pharmacological interventions in menopause management. Nutrients, 15(5), 1155. https://doi.org/10.3390/nu15051155
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Rashida Khan
Specialist Obstetrics and Gynaecology, American Medical Center, Dubai, UAE
Hind Marwan Ibrahim
Dubai Medical College UAE
Eman Mohammed Hashim
El-Razi Medical University, Khartoum, Sudan
Naya Isam Al Mikhi
Dubai Medical University for Girls, UAE
Samia Ashiq Raja
Obstetrics and Gynecology Resident, Dubai Health UAE
Rawda Ahmed Mehanna
Clinical Teaching Assistant, Clinical Sciences Department, Dubai Medical College for Girls, Dubai, UAE
Ayeza Majid
Clinical Training, Dubai Health, UAE
Areeb Jamil
RAK Medical & Health Sciences University, Ras Al Khaimah, UAE
Fatima Almarzooqi
Sheikh Shakhbout Medical City, Abu Dhabi, UAE
Amal Irfan Khazi
Al Qassimi Hospital, Sharjah UAE
Refaa Mujeeb Alji
RAK Medical and Health Sciences University, Ras Al Khaimah, UAE