OBJECTIVE: To systematically review the literature regarding the efficacy and 
safety of nonestrogen treatments for menopause-associated vasomotor symptoms not 
due to cancer or chemotherapy.
DATA SOURCES: Pertinent literature and clinical studies were identified by 
searching MEDLINE (1966-February 2004) and EMBASE (1959-February 2004) using the 
key search terms vasomotor symptoms, hot flashes, and menopause. Bibliographies 
of relevant articles were reviewed for additional references.
STUDY SELECTION AND DATA EXTRACTION: English-language articles reporting 
efficacy and safety of nonestrogen treatment modalities for perimenopausal and 
postmenopausal vasomotor symptoms were evaluated. All articles identified from 
the data sources were evaluated, and all information deemed relevant was 
included. Emphasis was placed on randomized, double-blind, placebo-controlled 
clinical trials, as these provide the best efficacy and safety data. Studies 
evaluating treatment of vasomotor symptoms from other causes, such as cancer or 
chemotherapy, were excluded.
DATA SYNTHESIS: Prescription medications reviewed for efficacy and safety in 
postmenopausal vasomotor symptoms include clonidine hydrochloride, danazol, 
gabapentin, methyldopa, mirtazapine, progestins, propranolol hydrochloride, 
selective serotonin-reuptake inhibitors (SSRIs), and venlafaxine. 
Nonprescription therapies reviewed include black cohosh, dong quai, evening 
primrose oil, physical activity, phytoestrogens, and red clover.
CONCLUSIONS: According to this systematic literature review, postmenopausal 
vasomotor treatments that have been shown to be safe and effective in short-term 
use include black cohosh, exercise, gabapentin, medroxyprogesterone acetate, 
SSRIs (ie, paroxetine hydrochloride), and soy protein. Initial, small reports 
are suggestive for efficacy in menopausal vasomotor symptoms with megestrol 
acetate and venlafaxine.