This evidence matrix provides an “at-a-glance” summary of the findings of the evidence review grouped by class of treatment and symptom.
Table 3: Evidence matrix based on primary and supplementary systematic reviews
Legend:
| Evidence of effect | Evidence of no effect | Limited evidence | No evidence |
Note: Bold text refers to evidence from studies in women with breast cancer, and non-bold text refers to evidence from general menopausal populations.
| Intervention | Vasomotor symptoms | Sleep disturbance | Vulvovaginal Symptoms and Sexual function | Breast cancer recurrence |
|---|---|---|---|---|
|
Bupropion
|
Limited evidence of no effect on hot flush severity with bupropion [ES1] |
No evidence Insomnia is a common side effect |
Limited evidence of no effect on sexual function with bupropion [ES25] |
Not reported |
|
Fluoxetine
|
Limited evidence of an inconsistent effect on hot flushes with fluoxetine [ES2] |
Limited evidence of no effect in sleep disturbance with fluoxetine [ES17] Insomnia is a common side effect |
Limited evidence of no effect on sexual function with fluoxetine [ES25] Sexual dysfunction is a common side effect |
Not reported |
|
Paroxetine
|
Limited evidence for reduction in hot flush frequency and severity with paroxetine [ES2] |
Limited evidence for improvement in sleep disturbance with paroxetine [ES17] |
Limited evidence of no effect on sexual function with paroxetine [ES25] |
Not reported |
|
Sertraline
|
Limited evidence of an inconsistent effect on hot flushes with sertraline [ES2] |
No evidence Insomnia is a common side effect |
No evidence |
Not reported |
|
Venlafaxine |
Evidence for reduction in frequency and severity of hot flushes with venlafaxine [ES3]
Evidence that venlafaxine and clonidine are equally effective at reducing the frequency and severity of hot flushes [ES3]
Limited evidence that gabapentin and venlafaxine have similar effectiveness [ES6]
Evidence for reduction in vasomotor symptom frequency and bother with venlafaxine [ES31] |
Limited evidence of no effect of venlafaxine on sleep [ES18] Insomnia is a common side effect |
Limited evidence of no effect on sexual function with venlafaxine [ES25] |
Not reported |
|
Zolpidem (augmented with SSRI/SNRI) |
Limited evidence of no additional effect on vasomotor symptoms with zolpidem when combined with an SSRI or SNRI [ES4] |
Limited evidence that adding zolpidem to an SSRI or SNRI improves sleep [ES19]
TGA approved treatment for insomnia |
No evidence |
Not reported |
|
Escitalopram |
Evidence for reduction in vasomotor symptom frequency and bother with escitalopram [ES30]
|
Limited evidence of no effect on sleep disturbance with escitalopram [ES49] Insomnia is a common side effect |
Limited evidence of no effect on sexual function with escitalopram [ES57] Sexual dysfunction is a possible side effect |
Not reported |
|
Desvenlafaxine |
Evidence for reduction in hot flush frequency with desvenlafaxine [ES32] |
Evidence for reduction in the number of night-time awakenings with desvenlafaxine [ES50] Insomnia is a common side effect |
No evidence Sexual dysfunction is a possible side effect |
Not reported |
|
Clonidine
|
Evidence for reduction in frequency and severity of hot flushes with clonidine. Evidence that this effect is comparable to the effect achieved with venlafaxine. [ES5] |
No evidence |
No evidence |
Not reported |
|
Gabapentin |
Limited evidence for reduction in hot flush frequency and severity with gabapentin [ES6]
Limited evidence that gabapentin and venlafaxine have similar effectiveness [ES6] |
Limited evidence of an inconsistent effect of gabapentin on sleep disturbance [ES20] |
No evidence |
Not reported |
|
Oestrogen/progesterone |
Limited evidence that menopause hormone therapy reduces hot flushes [ES7]
Evidence for reduction in hot flush frequency and severity with menopause hormone therapy [ES34] |
Evidence that menopause hormone therapy improves sleep quality [ES21] |
Limited evidence of inconsistent effect of menopause hormone therapy on sexual function [ES26]
Evidence of no effect on sexual function with menopause hormone therapy [ES62] |
Evidence that menopause hormone therapy increase breast cancer recurrence [ES29] |
|
Tibolone
|
Limited evidence that tibolone reduces the frequency and severity of hot flushes [ES7]
Evidence for reduction in hot flush frequency with tibolone [ES33] |
Limited evidence that tibolone improves sleep quality [ES21]
Limited evidence of no effect on insomnia with tibolone [ES51] |
Limited evidence of improved sexual function with tibolone [ES26]
Evidence of no effect on vaginal dryness and dyspareunia with tibolone [ES61] |
Evidence that tibolone increase breast cancer recurrence [ES29]
Limited evidence that tibolone reduces breast cancer recurrence [ES67] |
|
Oral low-dose oestradiol |
Limited evidence for reduction in hot flush frequency and severity with oestradiol [ES35]
Limited evidence for reduction in hot flush bother with oestradiol [ES35] |
No evidence |
No evidence
Limited evidence of no effect on sexual function with low-dose oestradiol [ES58] |
Increased risk of breast cancer recurrence* |
|
Low-dose oestradiol / low-dose transdermal oestradiol |
Evidence for a reduction in hot flush frequency with low-dose transdermal oestradiol [ES37] |
No evidence |
Limited evidence of no effect on sexual function with low-dose oestradiol [ES58] |
Increased risk of breast cancer recurrence* |
|
Transdermal oestradiol |
Evidence for a reduction in hot flush frequency and severity with transdermal oestradiol [ES38] |
No evidence |
No evidence |
Increased risk of breast cancer recurrence* |
|
Ospemifene / SERMs |
Evidence for increase in hot flushes with the selective oestrogen receptor modulator, ospemifene [ES36] |
No evidence |
Evidence for decreased dyspareunia with ospemifene [ES65]
Limited evidence of no effect in sexual function (composite score) with SERMs [ES65] |
Not reported |
|
Testosterone in combination with systemic menopause hormone therapy |
Limited evidence of no additional effect on vasomotor symptoms with testosterone added to menopause hormone therapy [ES39] |
No evidence |
Evidence that testosterone improves sexual function [ES59]
|
No evidence of the effect of testosterone on breast cancer recurrence [ES66] |
|
Testosterone (with or without menopause hormone therapy) |
No evidence |
No evidence |
Evidence of improvement in sexual function with testosterone [ES60] |
Not reported |
|
Compounded hormones |
Limited evidence of inconsistent effect of compounded progesterone cream on vasomotor symptoms [ES40] |
No evidence |
No evidence |
Not reported |
|
Vaginal pH-balanced gel
|
No evidence |
No evidence |
Limited evidence for improved vaginal symptoms with vaginal gel [ES27] |
Not reported |
|
Lidocaine gel |
No evidence |
No evidence |
Limited evidence for improved dyspareunia and vulvovaginal symptoms with lidocaine [ES27] |
Not reported |
|
Vaginal oestrogen |
No evidence |
No evidence |
Evidence that vaginally administered oestrogen relieves vaginal dryness and itching [ES63]
Evidence for a reduction in vaginal dryness, itching and burning, and dyspareunia with vaginal oestrogen [ES63] |
Not reported |
|
CBT or CBTI |
Evidence that CBT alone reduces the problem rating of hot flushes and night sweats [ES8]
Limited evidence of reduction in hot flushes and night sweats with CBT [ES41] |
Limited evidence that CBT improves sleep [ES22]
|
Limited evidence for improved sexual function with CBT alone [ES28] |
Not reported |
|
Hypnotherapy
|
Limited evidence for reduction in frequency and severity of hot flushes with a purpose-designed hypnotherapy protocol [ES9] |
Limited evidence that hypnotherapy improve sleep [ES22] |
Limited evidence that hypnotherapy has no effect on sexual function [ES28] |
Not reported |
|
Relaxation therapy
|
Limited evidence of reduction in hot flush frequency and severity with short-term relaxation therapy [ES11]
Limited evidence of no effect on vasomotor symptoms with relaxation [ES44] |
No evidence
Limited evidence of improvement on sleep with relaxation therapy [ES54] |
No evidence |
Not reported |
|
Physical exercise
|
Limited evidence that physical exercise in combination with CBT reduces the problem rating of hot flushes and night sweats [ES8]
Evidence of no effect on vasomotor frequency and bother with exercise [ES42] |
No evidence
Limited evidence of an inconsistent effect on sleep symptoms with exercise [ES52] |
Limited evidence for improved sexual function with CBT in combination with exercise [ES28] |
Not reported |
|
Yoga
|
Limited evidence for reduction in frequency and severity of hot flushes with yoga [ES12]
Limited evidence for improvement of total menopausal symptoms with Yoga and meditation [ES12]
Limited evidence of an inconsistent effect on vasomotor symptoms with yoga [ES43] |
Limited evidence that yoga improves sleep [ES23]
Limited evidence that yoga improve sleep symptoms [ES53] |
No evidence |
Not reported |
|
Acupuncture
|
Limited evidence of an inconsistent effect of acupuncture on the frequency and severity of hot flushes [ES10]
Limited evidence for an inconsistent effect on vasomotor symptoms with acupuncture [ES45] |
Limited evidence that acupuncture improves sleep [ES23] |
No evidence |
Not reported |
|
Magnetic therapy
|
Limited evidence of no effect on hot flushes frequency or severity with magnetic therapy [ES16] |
No evidence |
No evidence |
Not reported |
|
Homeopathy
|
Evidence of no effect on hot flush frequency or severity with homeopathy [ES14] |
No evidence |
No evidence |
Not reported |
|
Black cohosh
|
Evidence of no effect on severity or frequency of hot flushes with black cohosh [ES13]
Evidence of no effect on vasomotor symptoms with black cohosh [ES48] |
No evidence |
No evidence |
Not reported |
|
Phytoestrogens / isoflavones
|
Evidence of no effect on hot flush frequency or severity with phytoestrogens [ES15]
Limited evidence of an inconsistent effect on vasomotor symptoms with other isoflavones [ES46] |
No evidence
Limited evidence of no effect on sleep symptoms with isoflavones [ES55] |
No evidence
Limited evidence of an inconsistent effect on vaginal dryness and dyspareunia with soy isoflavones [ES64] |
Not reported |
|
Omega-3 supplementation |
Limited evidence of no effect on vasomotor symptoms with omega-3 fatty acid supplementation [ES47] |
No evidence
Limited evidence of no effect on sleep quality and insomnia with omega-3 fatty acid supplementation [ES56] |
No evidence |
Not reported |
|
Vitamin E
|
No evidence |
Limited evidence of no effect on sleep disturbance by Vitamin E [ES24] |
No evidence |
Not reported |
* The WHI study reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 79 years of age) during 5 years of treatment with conjugated oestrogens (0.625 mg) combined with medroxyprogesterone acetate (2.5 mg) relative to placebo.