Date of Award

11-2024

Document Type

Dissertation

Degree Name

Doctor of Medical Science (DMSc)

First Advisor

Jason Brumitt

Abstract

Roughly half of the population will experience menopause. Postmenopausal symptoms can present with physical and mental health manifestations, such as anxiety, depression, dyspareunia, vaginal dryness, brain fog, hot flashes, and night sweats. The latter two symptoms are collectively known as vasomotor symptoms.1,2 Up to 80% of postmenopausal women will experience vasomotor symptoms and about 10% will experience them as severe.3 Vasomotor symptoms are the leading reason why postmenopausal women seek medical evaluation.4 Not only are hot flashes bothersome throughout the day, but they often cause intense night sweats that contribute to insomnia and daytime fatigue.4 Vasomotor symptoms have also been associated with an increased risk of cardiovascular disease, bone loss, and bone turnover.5 This may demonstrate that vasomotor symptoms are not only impacting women socially and emotionally but may have lasting physical health changes as well.

The current therapies for vasomotor symptoms can be divided into two categories, hormonal and non-hormonal. Many women have contraindications to the use of hormone therapy such as a history of estrogen-dependent cancers, blood clotting disorders, and history of stroke.6 Until 2023, there was only one approved non-hormonal treatment for the relief of vasomotor symptoms from menopause. Paroxetine, a selective serotonin reuptake inhibitor (SSRI), was approved by the FDA in 2013 for the management of moderate to severe postmenopausal vasomotor symptoms.2 Until recently, many randomized clinical trials for the therapy of vasomotor symptoms have focused largely on SSRIs and selective norepinephrine reuptake inhibitors (SNRIs).

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