BACKGROUND: Vasomotor symptoms (VMSs) are the hallmarks of menopause, occurring in approximately 75% of postmenopausal women in the UK, and are severe in 25%.
OBJECTIVE: To identify which treatments are most clinically effective for the relief of VMSs for women in natural menopause without hysterectomy.
METHODS: English publications in MEDLINE, Embase, and The Cochrane Library up to 13 January 2015 were searched.
METHODS: Randomised controlled trials (RCTs) of treatments for women with a uterus for the outcomes of frequency of VMSs (up to 26 weeks), vaginal bleeding, and discontinuation.
METHODS: Bayesian network meta-analysis (NMA) using mean ratios (MRs) and odd ratios (ORs).
RESULTS: Across the three networks, 47 RCTs of 16 treatment classes (n = 8326 women) were included. When compared with placebo, transdermal estradiol and progestogen (O+P) had the highest probability of being the most effective treatment for VMS relief (69.8%; MR 0.23; 95% credible interval, 95% CrI 0.09-0.57), whereas oral O+P was ranked lower than transdermal O+P, although oral and transdermal O+P were no different for this outcome (MR 2.23; 95% CrI 0.7-7.1). Isoflavones and black cohosh were more effective than placebo, although not significantly better than O+P. Not only were selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) found to be ineffective in relieving VMSs, but they also had significantly higher odds of discontinuation than placebo. Limited data were available for bleeding, therefore no conclusions could be made.
CONCLUSIONS: For women who have not undergone hysterectomy, transdermal O+P was the most effective treatment for VMS relief.
CONCLUSIONS: Which treatment best relieves menopause flushes? Results from the #NICE guideline network meta-analysis.

Vasomotor symptoms are one of the main reasons for climateric women to consult a physician. Hormone therapy is the first treatment choice, but it is not indicated to all patients. Veralipride is an option for those who cannot or will not try hormone treatment. The Mexican Association for the Study of Climateric (AMEC) assembled an interdisciplinary group of medical experts so that they revised the medical literature on the subject and reached a consensus on veralipride indication, doses, counterindications and safety. The recommendations of the consensus conference on veralipride are: (1) Physicians must be familiar with its indication, side effects, pharmacokinetics and dosage. (2) Patients must be informed on other therapeutical options. (3) Patients\' mental and neurological state must be evaluated, in particular to identify movement disorders, extrapyramidal symptoms (tremor or dystonia), anxiety and depression that can be mistaken for climateric symptoms. (4) Any adverse effect associated with the drug must be reported. (5) A random multicenter trial must be carried out in order to identify the frequency and severity of side effects, and (6) Written information on possible health risks when using the drug must be provided.

In the Dutch College of General Practitioners\' practice guideline \'The menopause\', the menopause is viewed as a physiological phase of life with its associated discomforts, which sometimes require treatment. The GP should inform women with menopausal symptoms about the extent to which oestrogens can diminish vasomotor symptoms and about the benefits and risks of hormonal therapy on various organ systems. Oestrogens can be used when vasomotor symptoms cause serious limitations in daily life. First choice is a sequential combination of oestrogen and progestagen hormones, in which progestagens are given at least ten days per month. When urogenital complaints need to be treated, vaginally applied oestrogens can be prescribed. Depressive symptoms, fatigue, myalgia or arthralgia should not be treated with hormonal therapy. Nor are oestrogens recommended for the prevention of osteoporosis and cardiovascular diseases.

OBJECTIVE: Perimenopause refers to the time period around menopause. The clinical goal of peri-menopause therapy is to optimize the woman\'s health during and after this transitional period. However, clinical trial data are insufficient to establish evidence-based treatment standards regarding the diagnosis and treatment for both acute and chronic symptoms and conditions of perimenopausal women. Accordingly, The North American Menopause Society (NAMS) sought to develop a consensus opinion on clinical approaches to perimenopause.
METHODS: NAMS held a closed conference of experts in the field to review the current literature, share clinical experience, and make recommendations about how to help women achieve optimal health throughout perimenopause. The proceedings of the conference were used to assist the NAMS Board of Trustees in developing this consensus opinion of the Society.
RESULTS: On the basis of the conference proceedings, NAMS established the following recommendations for the treatment of perimenopausal women: (1) The annual health examination is valuable in the perimenopausal woman and should include comprehensive screening for physical and psychological problems as well as for appropriate lifestyle counseling. (2) Sufficient clinical data exist to provide recommendations for developing management plans for acute perimenopausal symptoms, as well as counseling for potential chronic diseases related to postmenopause. (3) The importance of individualized screening and management approaches for each woman is evident, as is the need for including the woman in the management decision-making process. (4) Because clinical research data on women in perimenopause are limited, healthcare providers may consider extrapolating data on postmenopausal women, as well as relying on clinical experience when considering management options. (5) Management of perimenopausal symptoms may include doing nothing (many symptoms may be self-limiting) or recommending a combination of treatments.
CONCLUSIONS: Although perimenopause is largely unstudied, many therapeutic approaches to the management of perimenopause disturbances exist, both prescription and nonprescription. NAMS established these consensus opinions to be a resource for clinicians when designing a healthcare plan for a perimenopausal woman. The perimenopausal woman\'s health and quality of life can be maintained and improved through preventive care, lifestyle modifications, early diagnosis of disease or increased risk for disease, and interventions when appropriate. However, more research is needed in all areas concerning perimenopausal women.

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