EVALUATING THE EFFICACY OF HORMONAL VERSUS NON-HORMONAL THERAPY IN MANAGING MENOPAUSAL SYMPTOMS AMONG MIDDLE AGED WOMEN

Abstract

Background: The management of menopausal symptoms remains a central issue in women's health, with menopausal hormone therapy (MHT) and various non-hormonal alternatives constituting the primary therapeutic avenues. A synthesis of contemporary, high-quality evidence directly comparing their efficacy is needed to inform clinical decision-making.

Objective: This systematic review aims to compare the efficacy of hormonal therapy versus non-hormonal therapies in managing vasomotor and other key menopausal symptoms among middle-aged women.

Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for randomized controlled trials (RCTs) published between 2014 and 2024. Inclusion criteria focused on RCTs comparing systemic MHT to non-hormonal therapies (e.g., SSRIs, SNRIs, CBT) for menopausal symptoms in perimenopausal or postmenopausal women. Data extraction and risk of bias assessment were performed independently by two reviewers using the Cochrane RoB 2 tool.

Results: Eight RCTs (n=1,842 participants) were included. Meta-analysis of five studies showed MHT provided a significantly greater reduction in vasomotor symptom frequency (MD -1.8 episodes/day, 95% CI -2.4 to -1.2; p<0.001) compared to SNRI/SSRI therapy. However, cognitive behavioral therapy (CBT) demonstrated comparable long-term efficacy to transdermal estradiol. Non-hormonal therapies were associated with greater improvements in psychological quality of life domains in some studies and a differentiated adverse event profile.

Conclusion: MHT is the most effective intervention for rapid vasomotor symptom relief. Non-hormonal therapies, particularly CBT, are viable alternatives, achieving comparable long-term results and offering benefits for psychological well-being. Treatment choice should be individualized based on symptom profile, risks, and patient preference. Further long-term comparative studies are warranted.