The effect of hormone therapy on women's quality of life in the first year of the Estonian Postmenopausal Hormone Therapy trial Menopausal Symptoms in Older Women and the Effects of Treatment With Hormone Therapy Hormone therapy in menopausal women with cognitive complaints The Women's Health Initiative postmenopausal hormone trials: overview and baseline characteristics of participants. [Influence of hormone replacement therapy on the quality of life in postmenopausal women with hypertension]. Dietary factors and vasomotor symptoms in breast cancer survivors: the WHEL Study Healthcare seeking and treatment for menopausal symptoms in the United States. Exercise participation, body mass index, and health-related quality of life in women of menopausal age. Aerobic exercise as a treatment for vasomotor menopausal symptoms: randomised controlled trial protocol. Treatment of Vasomotor Symptoms of Menopause with Black Cohosh, Multibotanicals, Soy, Hormone Therapy, or Placebo Paced Respiration for Vasomotor and Other Menopausal Symptoms: A Randomized, Controlled Trial Identifying meaningful differences in vasomotor symptoms among menopausal women The Effect of Education and Awareness on the Quality-of-Life in Postmenopausal Women Women's willingness to accept perceived risks for vasomotor symptom relief. Menopause and modifiable coronary heart disease risk factors: a population based study. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. Clinical assessment and quality of life of postmenopausal women treated with a new intermittent progestogen combination hormone replacement therapy: a placebo-controlled study
Background For postmenopausal women , the main reason to start hormone therapy ( HT ) is to reduce menopausal symptoms and to improve quality of life ( QOL ) . The aim of this study was to analyse the impact of HT on different aspects of symptom experience and QOL during a r and omised trial . A total of 1823 postmenopausal women were recruited into the Estonian Postmenopausal Hormone Therapy ( EPHT ) trial in 1999–2001 . Women were r and omised to blind HT , open-label HT , placebo or non-treatment arm . After one year in the trial , a question naire was mailed and 1359 women ( 75 % ) responded , 686 in the HT arms and 673 in the non-HT arms . Mean age at filling in the question naire was 59.8years . The question naire included Women 's Health Question naire ( WHQ ) to assess menopause specific QOL of middle-aged women together with a 17-item question naire on symptoms related to menopause , a question about painful intercourse , and a question about women 's self-rated health . Results After one year in the trial , fewer women in the HT arms reported hot flashes , trouble sleeping , and sweating on the symptom question naire . According to WHQ , women in the HT arms had fewer vasomotor symptoms , sleep problems , and problems with sexual behaviour , but more menstrual symptoms ;  HT had no effect on depression , somatic symptoms , memory , attractiveness , or anxiety . A smaller proportion of women reported painful intercourse in the HT arms . There were no significant differences between the trial arms in women ’s self-rated subjective health . Conclusions The results from the EPHT trial confirm that HT is not justified for treating symptoms , other than vasomotor symptoms , among postmenopausal women . WHQ proved to be a useful and sensitive tool to assess QOL in this age group of women OBJECTIVE In some women , hot flashes and other symptoms attributed to menopause persist for many years after the cessation of menses . The frequency and severity of such symptoms and response to hormone therapy in older women have not been well documented . METHODS We used data from the Heart and Estrogen/Progestin Replacement Study , a blinded , clinical trial among 2763 women with documented coronary disease and a uterus who were r and omized to receive either conjugated estrogens 0.625 mg plus medroxyprogesterone acetate 2.5 mg in one tablet or placebo .  Participants were queried at baseline and annually regarding menopausal symptoms . Breast symptoms were self‐reported , and uterine bleeding was recorded on a daily diary . RESULTS Symptoms associated with menopause were relatively common among Heart and Estrogen/Progestin Replacement Study participants , whose average age was 67 years and who averaged 18 years since menopause . At baseline , 16 % of women reported frequent hot flashes , 26 % vaginal dryness , 10 % genital irritation , 55 % trouble sleeping , and 53 % early awakening . Women assigned to hormone therapy reported less frequent hot flashes , vaginal dryness , and trouble sleeping compared with women assigned to placebo , but more frequent vaginal discharge , genital irritation , uterine bleeding , and breast symptoms . The reporting of breast symptoms among women in the hormone group decreased from 40 % at 1 year to 13 % by the 4th year . Uterine bleeding was reported by 31 % and spotting by an additional 33 % of women in the hormone group during the 1st year of treatment ; by the 4th year , these proportions had fallen to 11 % and 20 % , respectively . CONCLUSION Symptoms typically attributed to menopause are common in elderly women .  Postmenopausal hormone therapy  reduces hot flashes , trouble sleeping , and vaginal dryness , but at st and ard doses in elderly women is associated with vaginal discharge , genital irritation , uterine bleeding , and breast symptoms Objective : To evaluate the effects of hormone therapy ( HT ) on cognition and subjective quality of life ( QoL ) in recently postmenopausal women with cognitive complaints . Methods : Cognitive Complaints in Early Menopause Trial ( COGENT ) was a r and omized , double-blind , placebo-controlled , multicenter , pilot study of 180 healthy postmenopausal women aged 45 to 55 years , r and omly assigned to receive either placebo or conjugated equine estrogen 0.625 mg/medroxyprogesterone acetate 2.5 mg for 4 months . Outcome measures included memory , subjective cognition , QoL , sexuality , and sleep , which were assessed at baseline and month 4 . Results : The study was terminated before the expected final sample size of 275 due to a decrease in enrollment coinciding with the publication of findings from the Women ’s Health Initiative . There were no differences between groups on any cognitive or QoL measures , except for an increase in sexual interest and thoughts with HT . Modest negative effects on short- and long-term verbal memory approached significance ( p < 0.10 ) . Women with baseline vasomotor symptoms ( VMS ) showed a decrease in VMS and an improvement in general QoL , but no cognitive benefit vs placebo . Conclusions : With the power to detect an effect size of ≥0.45 , this study suggests potential modest negative effects on verbal memory that are consistent with previous hormone therapy trials in older women . GLOSSARY : BTA = Brief Test of Attention ; BVRT = Benton Visual Retention Test ; COGENT = Cognitive Complaints in Early Menopause Trial ; CRT = Educational Testing Service Card Rotation Test ; CVLT = California Verbal Learning ; FAS = Letter Fluency Test ; HERS = Heart and Estrogen/progestin Replacement Study ; HT = hormone therapy ; MFSQ = McCoy Female Sexuality Scale Question naire ; MFQ = The Memory Functioning Question naire ; PANAS = Positive and Negative Affect Scale ; PSQI = The Pittsburgh Sleep Quality Index ; QoL = subjective quality of life ; SWAN = Study of Women ’s Health Across the Nation ; UQoL = Utian Quality of Life ; VMS = vasomotor symptoms Test ; WHI = Women ’s Health Initiative ; WHISCA = WHI Study of Cognitive Aging ; WMS-R/DGT-F , MS-R/DGT-B = Digit Span Forward and Backward Subtests of the Wechsler Memory Scale – Revised The postmenopausal hormone therapy ( PHT ) component of the Women ’s Health Initiative ( WHI ) is composed of two r and omized , placebo-controlled , double-blind trials in postmenopausal women aged 50 to 79 years at initial screening , testing the effects of estrogen alone ( E-alone ) and estrogen plus progestin ( E P ) on coronary heart disease ( CHD ) as the primary outcome , hip and other fractures and colorectal cancer as secondary outcomes , and pulmonary embolism , breast and endometrial cancers as potential risks . The design and rationale of the PHT trials , including general eligibility and exclusion criteria and considerations regarding sample size and statistical power , have been described previously ( 1 ) . Postmenopausal hormones have been initiated in menopausal women for the treatment of vasomotor symptoms , mood disturbances , vaginal dryness , and prevention of rapid bone loss for several decades . Despite a paucity of data on effects of initiating hormone use in older women , postmenopausal hormones have also been promoted for the prevention of CHD , osteoporotic fractures , and other diseases that occur years after menopause ( 2 ) . It is generally recommended ( 2 ) that women with a uterus be prescribed a combination of estrogen and progestin to prevent AIM The effect of hormone replacement therapy ( HRT ) on the quality of life in women with hypertension is still not clear . Thus , the aim of the study was to assess the effect of hormone replacement therapy on quality of life in postmenopausal women with essential hypertension by using a battery of st and ardized question naires . MATERIAL AND METHODS The study population consisted of 53 women ( mean age 50.9 + /- 6.3 years ) with mild and moderate essential hypertension ( mean duration 6.4 + /- 6.4 years ) . The postmenopausal status was defined as the absence of menstrual blood loss during > 6 months and blood estradiol concentration < 50 pg/ml , accompanied by follicle-stimulating hormone ( FSH ) levels > 21 U/I. Twenty seven women were blindly r and omised to transdermal hormone replacement therapy ( HRT ) and received 17-beta-estradiol and noretisterone acetate , TTS .  Twenty six women were r and omly selected as controls . The subjects were evaluated at baseline ( after 2 weeks ' wash-out from hypotensive drug period ) and after three months of HRT using self-administered st and ardized quality of life question naires : the Psychological General Well-being Index ( PGWB ) and the Subjective Symptoms Assessment Profile ( SSA-P ) . RESULTS No differences were found in blood pressure values , heart rate , body mass index and distribution of body fat tissue between women receiving HRT and controls at baseline and after 3 months of follow-up . There were no significant differences in the baseline total PGWB score as well as in its subscale between two groups . Similarly , the frequency and intensity of subjective symptoms assessed by SSA-profile were the same in both groups at baseline . After 3 months , a significant improvement in PGWB total score was observed in women receiving HRT . This effect was due to improvement in anxiety , positive well-being and vitality . Moreover , emotional distress , symptoms of flushing , sweating and trembling h and s also diminished and sexual capacity improved in women treated with HRT . CONCLUSION A three-month hormone replacement therapy in hypertensive postmenopausal women slightly improves the general well-being , seems to decrease emotional tension , increase sexual capacity and markedly relieves some vasomotor symptoms Objective : Vasomotor symptoms (VMS)(hot flashes , night sweats ) are associated with natural or surgically or chemotherapy-induced menopause , the latter occurring frequently in women treated for breast cancer . To manage VMS , some women seek alternatives to menopausal hormone therapy , such as supplements or modified food choices . The objective of the present analyses was to assess associations of VMS occurrence and change in severity of VMS over 12 months with dietary intakes of fiber , fat , and selected soy-containing foods , and use of phytoestrogen or vitamin E supplements in women with recent early stage breast cancer , adjusting for covariates . Design : Using multivariate logistic regression , data were analyzed from 2,198 women with early-stage breast cancer who enrolled 2 to 48 months after diagnosis in the Women 's Healthy Eating and Living r and omized , controlled trial of a high-vegetable , high-fiber , reduced-fat diet .  Results : Being peri- or postmenopausal , using tamoxifen , having low social support or depressive symptoms , and using vitamin E or phytoestrogen supplements were significantly associated cross-sectionally with reporting moderate/severe VMS at enrollment . Increased symptom severity after 12 months was significantly associated with higher body mass index , tamoxifen use , and smoking . Decreased symptom severity at 12 months was significantly associated with high dietary fiber intake ; no decrease was observed in women who were peri- or postmenopausal , using tamoxifen , or had low fat intake or low social support . Conclusions High dietary fiber intakes , premenopausal , and high social support were related to decreased severity of VMS 1 year after study enrollment in women recently treated for breast cancer OBJECTIVES A population -based study was used to describe healthcare seeking behavior for  menopausal  symptoms and treatment among women 40 - 65 years old in the United States . METHODS Participants were recruited into the Menopause Epidemiology Study from the KnowledgePanel(SM ) , which is selected by r and om digit dialing and probability sampling from the US population . From this source , 6201 women 40 - 65 years old were contacted and 4402 women participated . From the 3135 peri- and postmenopausal women , detailed information was obtained on menopausal symptoms , healthcare seeking , medication usage , and symptom relief from the medication . RESULTS Many women ( 60 % ) reported seeking health care for their menopausal symptoms . More than half of these women sought health care in the past 12 months . Vasomotor symptoms were the most frequently reported menopause symptoms across all races/ethnicities , and the most common symptoms discussed with a health care professional . One-third of the women ( 34 % ) used only hormone therapies , 12 % used complementary and /or alternative medicines , and 16 % used both for treatment of menopausal symptoms . CONCLUSIONS This study has shown that a large number of women consult healthcare providers for menopausal symptoms , indicating these symptoms are bothersome . Yet , in the United States , there is considerable variation in the symptomatology , healthcare seeking , and use of therapies for menopausal symptoms across cultures . To alleviate these symptoms women have tried alternative treatments as well as hormone therapies , yet many women did not get complete relief of specific symptoms BACKGROUND Menopausal symptoms can affect women 's health and wellbeing . It is important to develop interventions to alleviate symptoms , especially given recent evidence result ing in many women no longer choosing to take hormone replacement therapy . Exercise may prove useful in alleviating symptoms , although evidence on its effectiveness has been conflicting . AIM To examine the association between exercise participation , body mass index ( BMI ) , and health-related quality of life in women of menopausal-age . DESIGN OF STUDY Survey of women of menopausal age . SETTING West Midl and s , Engl and . METHOD Women aged 46 - 55 years ( n = 2399 ) registered with six general practice s in the West Midl and s were sent a question naire containing items relating to demographics , lifestyle factors , weight , height , exercise participation , menopausal bleeding patterns , and health-related quality of life ( including vasomotor symptoms ) . RESULTS One thous and two hundred and six ( 50.3 % ) women replied . Women who were regularly active reported better health-related quality of life scores than women who were not regularly active ( P<0.01 for all significant subscales ) . No difference in vasomotor symptoms was recorded for exercise status . Women who were obese reported significantly higher vasomotor symptom scores than women of normal weight ( P<0.01 ) . Women who were obese reported significantly higher somatic symptoms ( P<0.001 ) and attractiveness concern scores ( P<0.001 ) than women of normal weight or those who were overweight . CONCLUSION The data suggest a positive association between somatic and psychological dimensions of health-related quality of life and participation in regular exercise .  Women with BMI scores in the normal range reported lower vasomotor symptom scores and better health-related quality of life scores than heavier women . Further evidence from high- quality r and omised controlled trials is required to assess whether exercise interventions are effective for management of menopausal symptoms BACKGROUND Evidence suggests that a high proportion of perimenopausal and postmenopausal women experience vasomotor symptoms ( hot flushes/night sweats ) that can be severe and disruptive and which are the principal reason for seeking medical intervention . Hormone therapy ( HT ) is known to be an effective treatment for troublesome hot flushes/night sweats but research has raised questions about the safety of HT and there have been negative high profile media reports about its use . Consequently many women are seeking alternatives and exercise might be one such option but there is a lack of high quality evidence on its effectiveness . AIMS This RCT initially aims to investigate the feasibility/acceptability of two exercise interventions identified from our previous preference study in 165 women , and if found to be feasible/acceptable , continue to recruit sufficient women ( n=261 ) to examine the effect of these interventions on hot flushes/night sweats and other outcomes relevant to menopausal women . METHOD We aim to recruit inactive perimenopausal and menopausal symptomatic women not using HT and r and omise them to one of two exercise interventions or usual care for six months . RESULTS We will assess outcomes at baseline and 6 and 12 months from r and omisation . CONCLUSION We hope this RCT will contribute towards increasing the evidence regarding the question of whether exercise is an effective treatment for vasomotor symptoms in women not taking HT Context Caution about taking estrogen for treating  postmenopausal vasomotor symptoms has led to increasing substitution of herbal regimens despite few tests of their effectiveness . Contribution The authors r and omly assigned 351 perimenopausal or postmenopausal women to herbal treatments ( black cohosh , multibotanicals , or multibotanicals plus counseling about dietary soy ) , estrogen with or without progesterone , or placebo . At 3 , 6 , and 12 months , patients receiving the herbal interventions had the same change in vasomotor symptoms as those receiving placebo ( except for more severe symptoms at 12 months for patients taking multibotanicals plus dietary soy ) . Estrogen substantially decreased vasomotor symptoms . Caution s Most participants were white and were well-educated . Implication s Herbal regimens did not reduce postmenopausal vasomotor symptoms in this sample of women . The Editors Hormone therapy remains the recommended treatment for vasomotor symptoms , but trials have shown serious risks with even short-term use ( 1 , 2 ) . The use of herbs , particularly black cohosh , multibotanical supplements , and dietary soy for menopausal symptoms has grown dramatically ( 36 ) . Few of these approaches have been scientifically evaluated . Women and providers are seeking safe , effective alternatives to hormone therapy . We design ed the Herbal Alternatives for Menopause Trial ( HALT ) to provide rigorous evidence on the efficacy and short-term safety of commonly used naturopathic approaches for management of vasomotor symptoms . Methods Design Overview and Setting HALT was a 1-year double-blind , r and omized , controlled trial design ed to investigate the effects of 3 naturopathic approaches for  vasomotor symptom relief and hormone therapy compared with placebo . Study methods have been described elsewhere ( 7 ) . The Group Health Institutional Review Board approved this study , and a data and safety monitoring committee monitored it . The study was conducted at Group Health , an integrated health plan in Washington State . Participants Eligibility criteria were as follows : age 45 to 55 years ; late menopausal transition ( 1 skipped menses within the preceding 12 months ) or postmenopausal ( no bleeding within 12 months , or follicle-stimulating hormone level > 20 IU/mL if patient had undergone hysterectomy without bilateral oophorectomy ) ; and 2 or more vasomotor symptoms per day over 2 weeks ( 6 moderate to severe symptoms ) . Women in menopausal transition were included because many are highly symptomatic and trial data are lacking for this group . Exclusion criteria were the following : contraindications to hormone therapy ; use of hormone therapy or oral contraceptives within 3 months before the trial ; use of herbal medicines for menopausal symptoms within 1 month before the trial ; soy allergy ; bilateral oophorectomy ; history of breast cancer ; and nonadherence during the run-in period ( < 80 % of capsules taken ) . From May 2001 through August 2003 , women were recruited by using direct mail . Screening calls determined initial eligibility . Women attended an orientation visit at which eligibility was confirmed , physical measurements were collected , and placebo medication and question naires for the 2-week run-in period were provided . R and omization and Interventions Participants were r and omly assigned by using SAS software ( SAS Institute , Inc. , Cary , North Carolina ) , stratified by previous hormone therapy and hysterectomy ; block sizes within strata ranged from 5 to 25 . Treatment assignments were sent to the University of Washington Research Pharmacy , where medications were bottled and labeled with a sequential identification number without treatment group indication . At the r and omization visit , vasomotor symptom diaries and medication counts were examined to confirm eligibility and adherence . The study nurse determined the appropriate stratum , assigned the participant the next study number in that stratum without knowledge of group assignment , and distributed study medications . The publication of results from the Women 's Health Initiative ( WHI ) estrogenprogestin trial ( 2 ) raised new concerns about the safety of estrogen therapy . New study participants were given the choice of 5-arm ( including hormone therapy ) versus 4-arm ( no hormone therapy ) r and omization . Current participants gave consent again , incorporating risk estimates from the WHI , and were given the option of finding out whether they had been assigned to hormone therapy ; 16 were unblinded , 1 discontinued use of the study drug , and all remained enrolled . Following publication of the WHI Memory Study ( 8 , 9 ) , we informed participants of those findings and restricted r and omization to herbs and placebo . No further women were unblinded or discontinued use of the study drug . Naturopathic medicine provided the model for study interventions . The herbal products , doses , and soy diet were based on approaches used by naturopaths when the study was design ed ( 7 ) . The study groups were as follows : 1 ) black cohosh  ( Actaea racemosa or Cimicifuga racemosa , 160 mg daily ; 2.5 % triterpene glycosides ; 70 % ethanol extract ) ; 2 )  multibotanical ;  3 )  multibotanical plus soy diet counseling ; 4 ) conjugated equine estrogen , 0.625 mg daily , with ( for women with a uterus ) or without ( for women without a uterus ) medroxyprogesterone acetate , 2.5 mg ; and 5 ) placebo . The multibotanical delivered daily doses of the following : black cohosh , 200 mg ; alfalfa ( Medicago sativa ) , 400 mg ; boron , 4 mg ; chaste tree ( Vitex agnus-castus ) , 200 mg ; dong quai ( Angelica sinensis ) , 400 mg ; false unicorn ( Chamaelirium luteum ) , 200 mg ; licorice ( Glycyrrhiza glabra ) , 200 mg ; oats ( Avena sativa ) , 400 mg ; pomegranate ( Punica granatum ) , 400 mg ; Siberian ginseng ( Eleutherococcus senticosus , st and ardized constituents 0.8 % eleutherosides E and B ) , 400 mg . Black cohosh was provided by Pure World , Inc. , ( Hackensack , New Jersey ) . The multibotanical , ProGyne , was purchased from Progena Professional Formulations ( Albuquerque , New Mexico ) and encapsulated to study specifications . Both companies follow current good manufacturing practice s , and single batches were used . ConsumerLab.com ( White Plains , New York ) tested the products after the study commenced . Dong quai , false unicorn , and pomegranate were not detected , suggesting that they were of poor quality or did not contain the tested marker compounds . Other marker compounds were detected in the approximate doses as labeled ( 7 ) . The Appendix Table describes the herbal products in detail . Appendix Table . Consoli date d St and ards of Reporting Trials ( CONSORT ) Requirements for Controlled Trials of Herbal Interventions To facilitate blinding , medications and lactose placebo were encapsulated to provide 2 white and 2 blue capsules to each woman , and medication boxes were labeled with a unique identification number that did not indicate study group . The soy food intervention was modeled after a successful 5-a-day intervention ( 10 ) . We chose soy foods because of uncertainty about the efficacy of isoflavone supplements and because naturopaths commonly recommend whole soy foods . Participants received 5 telephone calls from a clinical dietitian and a 34-page booklet recommending 2 soy food servings per day ( 12 to 20 g of soy protein ) ( 7 ) . Other participants received 1 telephone call and a similar booklet reinforcing fruit and vegetable intake . Participants were instructed not to discuss dietitian calls with study nurses and were unaware that soy counseling was linked to the multibotanical . Outcomes and Measurements The primary outcomes were change from baseline ( measured over 2-week run-in period ) to 3 , 6 , and 12 months ( each measured for 4 weeks ) and change from baseline to the average for all follow-ups with regard to the mean frequency and intensity of vasomotor symptoms ( daytime hot flashes plus night sweats ) and the mean Wiklund Vasomotor Symptom Subscale score ( 11 , 12 ) . We also evaluated change from baseline to follow-up ( months 3 , 6 , and 12 and average change ) for daytime hot flash rate , night sweat rate , and the total Wiklund Menopause Symptom Scale score . Symptom diaries and global ratings of menopause symptoms are almost universally used in studies of vasomotor symptoms . Participants used a  vasomotor symptom diary  to record daytime hot flashes and night sweats , rating intensity as mild , moderate , or severe ( scale , 1 to 3 ) , as recommended by the U.S. Food and Drug Administration ( 13 ) . Women completed the Wiklund Menopause Symptom Scale , rating the severity of 13 menopausal symptoms ( sweats , hot flashes , sleep disturbance , fatigue , vaginal dryness , depression , headache , irritability , muscle/joint pain , breast tenderness , nervousness , palpitations , and dizziness/fainting on a scale of 0 ( none ) to 10 ( severe ) ( 11 ) . Soy food intake was monitored by using a self-reported , vali date d soy food question naire ( 14 ) . Follow-up Procedures Participants returned to the research clinic at 3 , 6 , and 12 months . Question naires were collected , and study medication was dispensed . Medication adherence counts were conducted by staff without participant contact and without knowledge of treatment assignment . Study nurses encouraged adherence and monitored adverse events during monthly telephone calls and at visits . Adverse events were identified through participants ' responses to the question , Have you had any medical problems or been hospitalized ? Responses were recorded and adverse events were followed until they were resolved . The study nurse determined intensity ( mild , moderate , or severe ) and whether the event was serious ( yes or no ) . Events were review ed by the study physician , who determined whether the event was study related , without knowledge of group assignment . Adverse events were coded by using the Coding Symbols for Thesaurus of Adverse Reaction Terms ( 15 ) . The Data and Safety Monitoring Committee review ed study progress and unblinded outcome and safety data 5 times . Statistical Analysis The study was powered to detect an effect of ABSTRACT BACKGROUND Paced respiration has been internationally recommended for vasomotor symptom management , despite limited empirical evidence . OBJECTIVE To evaluate efficacy of a paced respiration intervention against breathing control and usual care control for vasomotor and other menopausal symptoms . DESIGN A 16-week , 3-group , partially blinded , controlled trial with 2:2:1 r and omization and stratification by group ( breast cancer , no cancer ) , in a Midwestern city and surrounding area . PARTICIPANTS Two hundred and eighteen r and omized women ( 96 breast cancer survivors , 122 menopausal women without cancer ) , recruited through community mailings and registries ( 29 % minority ) . INTERVENTIONS Training , home practice support , and instructions to use the breathing at the time of each hot flash were delivered via compact disc with printed booklet ( paced respiration intervention ) or digital videodisc with printed booklet ( fast shallow breathing control ) . Usual care control received a letter regarding group assignment . MAIN MEASURES Hot flash frequency , severity , and bother ( primary ) ; hot flash interference in daily life , perceived control over hot flashes , and mood and sleep disturbances ( secondary ) . Intervention performance , adherence , and adverse events were assessed . KEY RESULTS There were no significant group differences for primary outcomes at 8-weeks or 16-weeks post-r and omization . Most intervention participants did not achieve 50 % reduction in vasomotor symptoms , despite demonstrated ability to correctly do paced respiration and daily practice . Statistically significant differences in secondary outcomes at 8 and 16 weeks were small , not likely to be clinical ly relevant , and as likely to favor intervention as breathing control . CONCLUSIONS Paced respiration is unlikely to provide clinical benefit for vasomotor or other menopausal symptoms in breast cancer survivors or menopausal women without cancer Objective : First , to identify treatment satisfaction thresholds for interpreting treatment-related changes in vasomotor symptoms , and , second , to determine the doses of desvenlafaxine ( DVS ) ( administered as desvenlafaxine succinate ) that effectively provide relief of vasomotor symptoms considered important by menopausal women . Design : Efficacy and treatment satisfaction were assessed in 620 postmenopausal women with moderate to severe vasomotor symptoms participating in a double-blind , placebo-controlled trial and r and omly assigned to placebo or 50 , 100 , 150 , or 200 mg DVS .  Number and severity of hot flushes and number of nighttime awakenings were recorded in daily diaries for 12 weeks of treatment . At week 12 , responses to the Menopause Symptoms Treatment Satisfaction Question naire were compared with efficacy results . Results : Greater percentages of participants in the DVS groups reported being " satisfied " or " extremely satisfied " with daytime and nighttime control of hot flushes compared with placebo . The treatment satisfaction threshold , defined as the difference between the average reduction in vasomotor symptoms for women who were " neutral " versus " satisfied , " was 1.64 for moderate to severe hot flushes and 0.42 for nighttime awakenings . Statistically significant reductions with 100 , 150 , and 200 mg DVS exceeded treatment satisfaction threshold results for at least one of these thresholds , and results with 100 mg DVS compared with placebo exceeded both treatment satisfaction thresholds . Conclusions : Among menopausal women with moderate to severe vasomotor symptoms , the treatment satisfaction thresholds that were meaningful to participants were 1.64 fewer moderate to severe hot flushes per day and 0.42 fewer nighttime awakenings per night . A dose of 100 mg DVS met both of these important vasomotor symptom change thresholds Objectives : Women are one of the most important parts of the family and society , and community health is dependent on provision of the needs of this group . Menopause is one of the most critical stages of life among women . One of the aims of health services for all of the people in the 21st century is improvement of the quality -of-life . In menopausal women , the term quality -of-life incorporates its physical symptoms such as hot flushes , night sweats and vaginal mucosa dryness . We set out this study in order to evaluate the effect of education on the quality -of-life and the improvement of health st and ards in menopausal women . Material s and Methods : Sixty-two women aged 44–55 referring to and academic outpatient clinic in Shiraz were selected by simple r and om sampling , and allocated in two groups . Data was collected using a modified Hildich question naire on quality -of-life in menopause stage . Quality -of-life of the subjects ( vasomotor , psychosocial , physical and sexual aspects ) were evaluated prior to and 3 months after educational intervention . Results : Mean quality -of-life score in study and control groups , prior to education , was 81.7 and 74.8 ; changing to 75.3 and 75.8 , respectively three months after intervention . The study group showed a significant improvement in their quality -of-life ( P = 0.001 ) . A significant difference was seen between groups in terms of changing quality -of-life after intervention ( P = 0.001 ) . Conclusions : Appropriate training to menopausal women improves their quality -of-life and promotes their health BACKGROUND Evidence that long-term hormone therapy ( HT ) may increase the risk of serious adverse events led to a sharp reduction in all HT use , including short-term use for vasomotor symptom relief . We estimated women 's willingness to accept adverse event risks in exchange for vasomotor symptom relief when risks are communicated in absolute vs. relative terms . METHODS We developed a conjoint survey to elicit preferences across benefit and risk attributes of HT . The survey was administered via the Internet to 523 U.S. women aged 46 - 60 years . Participants evaluated pairs of hypothetical treatments and indicated preferences using a Likert-based scale . Risks were presented in absolute and relative terms . Satisfaction scores for HT risks and benefits were estimated using r and om-effects , ordered-probit regression . Maximum acceptable risk ( MAR ) was calculated as the increase in risk that reduces the satisfaction score for a given level of HT benefit to 0 . RESULTS For both risk versions , the least important attribute ( smallest difference in satisfaction scores ) was night sweat frequency ; heart attack risk was the most important ( largest difference in scores ) . Participants were more willing to accept risks in return for symptom relief when shown absolute vs. relative risks , although differences in MAR were statistically significant only for breast cancer risk . MARs for breast cancer and heart attack exceeded reported rates in most cases . CONCLUSIONS Many women may be willing to accept risks to control vasomotor symptoms . However , describing risks in different , but technically equivalent , ways affects women 's willingness to trade risks for benefits OBJECTIVES The aim of our study was to determine the effect of the menopause on various coronary heart disease ( CHD ) risk factors and on the global risk of CHD in a population based sample of women , making the difference between menopause and age related effects . STUDY DESIGN The Third French MONICA cross-sectional survey on cardiovascular risk included 1730 r and omly selected women , aged 35 - 64 years , representative from the general population . MAIN OUTCOME MEASURES Women were defined as post-menopausal ( postM ; n=696 ) , peri-menopausal ( periM ; n=183 ) or pre-menopausal ( preM ; n=659 ) based on the date of last menses . Socio-demographic , clinical and biological data were collected . Analyses of variance were used to compare means . RESULTS PostM women had significantly higher age-adjusted levels of total cholesterol ( 6.0mmol/L in postM vs. 5.7mmol/L in preM , p<0.05 ) and LDL cholesterol ( 3.9mmol/L vs. 3.6mmol/L , p<0.05 ) . There was no difference in HDL cholesterol or triglyceride levels , glycemia or blood pressure . Further adjustment on body mass index and hormonal treatments did not modify the results . No risk factor was significantly different between periM and postM. However , the Framingham 10-year risk of CHD was higher in postM , as compared with periM ( 5.1 % vs. 5.0 % , p<0.05 ) . In postM women , lipids and the Framingham risk were not associated with elapsed time since menopause . CONCLUSIONS The CHD risk increases during the sixth decade could be explained not only by estrogen deprivation but also by an effect on lipid profile , which is likely to occur in the peri-menopause period CONTEXT The timing of initiation of hormone therapy may influence its effect on  cardiovascular disease .  OBJECTIVE To explore whether the effects of hormone therapy on risk of cardiovascular disease vary by age or years since menopause began . DESIGN , SETTING , AND PARTICIPANTS Secondary analysis of the Women 's Health Initiative ( WHI ) r and omized controlled trials of hormone therapy in which 10,739 postmenopausal women who had undergone a hysterectomy were r and omized to conjugated equine estrogens ( CEE ) or placebo and  16,608 postmenopausal women who had not had a hysterectomy  were r and omized to CEE plus medroxyprogesterone acetate ( CEE + MPA ) or placebo .  Women aged 50 to 79 years were recruited to the study from 40 US clinical centers between September 1993 and October 1998 . MAIN OUTCOME MEASURES Statistical test for trend of the effect of hormone therapy on coronary heart disease ( CHD ) and stroke across categories of age and years since menopause in the combined trials . RESULTS In the combined trials , there were 396 cases of CHD and 327 cases of stroke in the hormone therapy group vs 370 [ corrected ] cases of CHD and 239 cases of stroke in the placebo group . For women with less than 10 years since menopause began , the hazard ratio ( HR ) for CHD was 0.76 ( 95 % confidence interval [ CI ] , 0.50 - 1.16 ) ; 10 to 19 years , 1.10 ( 95 % CI , 0.84 - 1.45 ) ; and 20 or more years , 1.28 ( 95 % CI , 1.03 - 1.58 ) ( P for trend = .02 ) . The estimated absolute excess risk for CHD for women within 10 years of menopause was -6 per 10,000 person-years ; for women 10 to 19 years since menopause began , 4 per 10,000 person-years ; and for women 20 or more years from menopause onset , 17 per 10,000 person-years . For the age group of 50 to 59 years , the HR for CHD was 0.93 ( 95 % CI , 0.65 - 1.33 ) and the absolute excess risk was -2 per 10,000 person-years ; 60 to 69 years , 0.98 ( 95 % CI , 0.79 - 1.21 ) and -1 per 10,000 person-years ; and 70 to 79 years , 1.26 ( 95 % CI , 1.00 - 1.59 ) and 19 per 10,000 person-years ( P for trend = .16 ) . Hormone therapy increased the risk of stroke ( HR , 1.32 ; 95 % CI , 1.12 - 1.56 ) . Risk did not vary significantly by age or time since menopause . There was a nonsignificant tendency for the effects of hormone therapy on total mortality to be more favorable in younger than older women ( HR of 0.70 for 50 - 59 years ; 1.05 for 60 - 69 years , and 1.14 for 70 - 79 years ; P for trend = .06 ) . CONCLUSIONS Women who initiated hormone therapy closer to menopause tended to have reduced CHD risk compared with the increase in CHD risk among women more distant from menopause , but this trend test did not meet our criterion for statistical significance . A similar nonsignificant trend was observed for total mortality but the risk of stroke was elevated regardless of years since menopause . These data should be considered in regard to the short-term treatment of menopausal symptoms . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00000611 Objective The aim of this study was to evaluate the effects of a constant-estrogen , intermittent-progestogen hormone replacement regimen ( Ortho-Prefest , Ortho-McNeil Pharmaceutical , Raritan , NJ , USA ) on menopausal symptoms measured by the Kupperman Index and on quality of life measured by the Menopause Quality of Life-Intervention question naire . Design This was a r and omized , double-blind , placebo-controlled multicenter study of 90 days ' duration . Nonhysterectomized , postmenopausal women with vasomotor symptoms and at least 6 months ' amenorrhea were eligible . On completion of the placebo-controlled portion of the study , participants could elect to receive active treatment for an additional 90 days . Results The study enrolled 119 participants , 59 and 60 in the Prefest and placebo groups , respectively . A marked reduction of menopausal symptoms , as measured by the Kupperman Index , was observed in the active treatment group compared with the placebo group after 45 days ' treatment ( mean reduction , 14.8 v 7.2 points , respectively ) , which was sustained to day 90 ( 16.8 v 7.8 points;P < 0.001 ) . Similarly , greater improvement in quality of life , as measured by the Menopause Quality of Life summary score , was also observed in the active treatment group for the same period ( improvement of up to 1.6 points v 0.7 points;P < 0.001 ) . The adverse event profile was unremarkable . Of the 114 participants who received the active treatment , 6 withdrew because of adverse events . Conclusions The constant-estrogen , intermittent-progestogen regimen was highly effective in relieving menopausal symptoms and in improving quality of life and was well received by the study participants
The results showed that low-dose oral and transdermal estrogen in all dose ranges were more likely than placebo to decrease the frequency of VMS .
Indeed , the nanostructured formulation was safe and effective in relieving the symptoms of menopause .
Low-dose estrogen-based therapies can be the most effective regimens to relieve VMS .
These medications can be used by different administration routes and formulations
BACKGROUND Menopause is a critical phenomenon in women 's life .
After cardiac diseases , menopause is the second major cause of living with a disability in 45 - 60 year old women .
The majority of women will experience bothersome  vasomotor symptoms ( VMS ) .
Menopausal hormone therapy ( MHT ) is the most effective treatment for these symptoms .
The objective of this review is to focus on hormone therapy for relieving postmenopausal vasomotor symptoms .