Research shows that
women want4:

  • Credible treatment information
  • Facts about diagnosis
  • Open and honest conversations

Get the conversation
started

VMS SURVEY
TOOL

Identify frequency and
disruptiveness

NEURONAL
INFLUENCE ON VMS

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session

It’s time to take
VMS off the back
burner

Helping women with VMS has become increasingly difficult and complex over the past 20 years due to patients receiving conflicting information from various sources.4

There has been an 84% decline in hormone therapy (HT) prescriptions for menopause-related symptoms.5

FDA-APPROVED HORMONE
THERAPY Rx VOLUME5*

FDA-approved hormone therapy Rx volume from 1992 to 2020, based on IQVIA TRx prescription data.

*Based on IQVIA TRx prescription data from 1992-2020.

HT remains the standard of care for VMS, but may not be appropriate for every patient6,7

  • Safety outcomes from the WHI study brought about concerns with HT1,7

    • Patients may have contraindications for use of HT, and certain considerations like age, onset of menopausal symptoms, and
      medical histories need to be taken into account6

    • Patients may have concerns about the risk/benefit profile4

  • Subsequent analyses of these data have demonstrated that HT is safe and effective when initiated in the appropriate patient at the
    right time, formulation, and dose6

  • However, even with these data, prescriptions have not rebounded, leaving some women with minimal options5

Healthcare is trending toward targeted treatment, but VMS are lacking innovation. Other menopausal conditions like vulvovaginal
atrophy (VVA) and osteoporosis have seen targeted innovations; however, VMS have seen very few.4,6,8

FDA-APPROVED HORMONE THERAPY
Rx VOLUME8*

FDA-approved hormone therapy Rx volume from 1992 to 2020, based on IQVIA TRx prescription data.

*Based on IQVIA TRx prescription data from 1992-2020.

Treatment strategies for VMS

TREATMENTSAFETYEFFICACY
Estrogen therapy
  • Adverse events include breast tenderness, vaginal bleeding, and bloating
  • Includes a boxed warning that refers to stroke, deep
    vein thrombosis, endometrial cancer,† and dementia‡; estrogen therapy should not be used for the
    prevention of cardiovascular disease or dementia
Up to 75% reduction in frequency and 87% reduction in severity
Estrogen-progestin therapy
  • Adverse events include breast tenderness, vaginal bleeding, and bloating
  • Includes a boxed warning that refers to stroke, deep vein
    thrombosis, pulmonary emboli, myocardial infarction,
    invasive breast cancer, and dementia‡; estrogen therapy
    should not be used for the prevention of cardiovascular
    disease or dementia
Estrogen combined
with estrogen
agonist/antagonist
  • Adverse events include infection, pain, arthralgia, and
    headache
  • Includes a boxed warning that refers to stroke, deep
    vein thrombosis, endometrial cancer,† dementia,‡ and
    use with additional estrogens; estrogen therapy
    should not be used for the prevention of
    cardiovascular disease or dementia
74% reduction in
frequency and
significant reductions in
severity

TREATMENT

Estrogen therapy

SAFETY

  • Adverse events include breast tenderness, vaginal bleeding, and bloating
  • Includes a boxed warning that refers to stroke, deep vein thrombosis, endometrial cancer,† and dementia‡; estrogen therapy should not be used for the prevention of cardiovascular disease or dementia

EFFICACY

Up to 75% reduction in frequency and 87% reduction in severity

TREATMENT

Estrogen-progestin therapy

SAFETY

  • Adverse events include breast tenderness, vaginal bleeding, and bloating
  • Includes a boxed warning that refers to stroke, deep vein thrombosis, pulmonary emboli, myocardial infarction, invasive breast cancer, and dementia‡; estrogen therapy should not be used for the prevention of cardiovascular disease or dementia

EFFICACY

Up to 75% reduction in frequency and 87% reduction in severity

TREATMENT

Estrogen combined with estrogen agonist/antagonist

SAFETY

  • Adverse events include infection, pain, arthralgia, and headache
  • Includes a boxed warning that refers to stroke, deep vein thrombosis, endometrial cancer,† dementia,‡ and use with additional estrogens; estrogen therapy should not be used for the prevention of cardiovascular disease or dementia

EFFICACY

74% reduction in frequency and significant reductions in severity

Other forms of estrogen and progestin may have different risks, such as lower risk of various thromboembolism with transdermal estrogen vs oral estrogen (as indicated by some observational studies). Estrogens
with or without progestins should be
prescribed at the lowest effective doses
and for the shortest duration consistent
with treatment goals and risks for the
individual woman.

† In women with a uterus who use unopposed estrogens.

‡In postmenopausal women 65 years of age and older.

TREATMENTSAFETYEFFICACY
SSRI§
  • Adverse events include nausea, headache, and
    dizziness
  • Includes boxed warning for suicidal thoughts and
    behaviors in pediatrics and young adults
33–65% reduction in frequency and
significant reductions in severity

TREATMENT

SSRI§

SAFETY

  • Adverse events include nausea, headache, and dizziness
  • Includes boxed warning for suicidal thoughts and behaviors in pediatrics and young adults

EFFICACY

33-65% reduction in frequency and significant reductions in severity

§SSRI=selective serotonin reuptake inhibitor.

TREATMENTSAFETYEFFICACY
Supplements and herbal therapies

Evidence of safety of unregulated products is limited

 Inconsistent evidence of clinical benefit more than placebo

TREATMENT

Supplements and herbal therapies

SAFETY

Evidence of safety of unregulated products is limited

EFFICACY

Inconsistent evidence of clinical benefit more than placebo

Middle age menopausal Black woman

VMS IN HER WORDS

“It’s like a snowball [effect]; I don’t
sleep well, then I wake up tired, and
because I am tired, I am irritable.
[Then] I get mad at myself when I am
irritable because I should be patient
with people, especially the ones that I
love.”

VMS IN HER WORDS

“It’s like a snowball [effect]; I don’t
sleep well, then I wake up tired, and
because I am tired, I am irritable.
[Then] I get mad at myself when I am
irritable because I should be patient
with people, especially the ones that I
love.”

References: 1. Sarrel P, Portman D, Lefebvre P, et al. Incremental direct and indirect costs of untreated vasomotor symptoms. Menopause 2015;22(3):260-6.
2. Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. Symptoms of menopause - global prevalence, physiology and implications. Nat Rev Endocrinol 2018;14(4):199-215. 3. Ortman JM, Velkoff VA, Hogan H. An aging nation: the older population in the United States, Current Population Reports, P25-1140. US Census Bureau, Washington, DC. 2014. 4. Parish SJ, Nappi RE, Kingsberg S. Perspectives on counseling patients about menopausal hormone therapy: strategies in a complex data environment. Menopause 2018;25(8):937-49. 5. IQVIA ISMART Dataset. TRx Volume for Oestrogens and Oestrogen + Progestogens. 1992-2020.
6. Pinkerton JV. Hormone therapy for postmenopausal women. N Engl J Med 2020;382(5):446-55. 7. Thurston RC. Vasomotor symptoms. In: Crandall CJ, Bachman GA, Faubion SS, et al., eds. Menopause Practice: A Clinician’s Guide. 6th ed. Pepper Pike, OH: The North American Menopause Society, 2019:43-55. 8. Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2016;31(1):16-35. Erratum in: J Bone Miner Res 2016;31(10):1910. 9. Kaunitz AM, Manson JE. Management of menopausal symptoms. Obstet Gynecol 2015;126(4):859-76. 10. Goldberg T, Fidler B. Conjugated Estrogens/Bazedoxifene (Duavee): a novel agent for the treatment of moderate-to-severe vasomotor symptoms associated with menopause and the prevention of postmenopausal osteoporosis. P T 2015;40(3):178-82. 11. Carroll DG, Lisenby KM, Carter TL. Critical appraisal of paroxetine for the treatment of vasomotor symptoms. Int J Womens Health 2015;7:615-24. 12. Fornaro M, Anastasia A, Valchera A, et al. The FDA “Black Box” Warning on antidepressant suicide risk in young adults: more harm than benefits? Front Psychiatry (Epub) 05-03-2019. 13. The NAMS 2015 Position Statement Advisory Panel. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of the North American Menopause Society. Menopause 2015;22(11):1155-72.
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