The MsFLASH Research Network: Latest Findings

Publication Type:

Journal Article


Menopause-the Journal of the North American Menopause Society, Volume 20, Number 12, p.1315-1315 (2013)


2013, March 2014, Public Health Sciences Division, Public Health Sciences Division March 2014 2014Q1 CCSG


Estrogen therapy (ET) is the gold standard treatment for hot flashes and night sweats (vasomotor symptoms, VMS), but some women are unable or unwilling to use it because of associated risks. The serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine is used widely as a non-hormonal alternative pharmacologic treatment for VMS. While clinical impression is that venlafaxine is less effective than ET, no previous clinical trials have simultaneously included treatment groups of ET, venlafaxine and placebo, limiting the ability to address this important clinical question. This session will feature the results from the recently completed MsFLASH double-blind, randomized controlled trial which quantifies the individual effects of low-dose oral estradiol and venlafaxine vs. matching placebo for relief of VMS, as well as several other common menopause-related symptoms including insomnia, perceived sleep quality, vaginal discomfort, and sexual dysfunction. We will report the results of a randomized, placebo controlled trial that enrolled 339 peri- and postmenopausal women with ≥2 bothersome VMS per day (mean 8.1 ± 5.3/day) to treatment with low-dose oral 17-beta-estradiol 0.5-mg/day (n=97), low-dose venlafaxine XR 75-mg/day (n=96), or placebo (n=146) for 8 weeks. 94% of women were adherent to study medication and completed 8-week VMS diaries. Intentto- treat analyses compared change in VMS frequency, the primary outcome, between each active intervention and placebo. Dr. Joffe will present the primary VMS outcome results of the trial. Dr. Newton will present the results for treatment effects on insomnia symptoms as measured by the Insomnia Severity Index and perceived sleep quality as measured by the Pittsburgh Sleep Quality Index. Dr. Reed will present the results for treatment effects on vaginal symptoms and sexual function, as well as preliminary findings related to the postmenopausal vaginal microbiota and the vaginal microbiome. Finally, Dr. Guthrie will present the results of a joint analysis of the three MsFLASH randomized controlled trials comparing treatment effects of 6 interventions vs. placebo on VMS frequency, severity and bother: escitalopram, aerobic exercise, yoga, Omega-3 supplementation, low dose estradiol and venlafaxine. These findings will allow practitioners to counsel women with menopause symptoms on how these treatments compare with respect to relief of VMS.


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