A pill or a patch for a hot flush?

We will be discussing: Vasomotor symptoms due to natural menopause; systematic review and network meta-analysis (NMA) of treatment effects from the NICE Menopause Guideline by Sarri and colleagues.

Wednesday 26th July 2017, 8pm BST

Scenario
A 52 year old woman presents to your clinic with hot flushes and night sweats coinciding with the menopause. She does not wish to have an operation. What treatments do you recommend?

Description of research

Participants: 8326 women participating in 47 randomised controlled trials of medications and therapies to control
Interventions:
1) Transdermal oestradiol and progesterone
2) Oral oestradiol and progesterone
3) Isofavones
4) Black cohosh
5) Chinese herbal medicine
6) Multibotanicals
7) Acupuncture
8) SSRIs
9) SNRIs
Comparison: Placebo and sham acupuncture
Outcomes: Odds ratios and means ratios of vasomotor symptoms (hot flushes and night sweats)
Study Design: Bayesian network meta-analysis (NMA)

Discussion points

  • What advice do you currently give women in the situation above?
  • In your experience, do women find pills or patches (a) more acceptable and (b) easier to use?
  • What is a network meta-analysis?
  • What does it mean for such an analysis to be Bayesian? How would you explain the methods used to another clinician?
  • There are many interventions in this analysis and many possible interactions. What problems does this present?
  • Would you change your recommendations to the women you treat as a result of this analysis?
  • Papers such as this use innovative statistical methods to answer real-life clinical questions. Consider your answers to questions 4 and 6. Is your answer to question 6 dependent on your answer to question 4? If so, how and why?

Suggested reading

Ades AE, Caldwell DM, Reken S, Welton NJ, Sutton AJ, Dias S. Evidence Synthesis for Decision Making 7. Med Decis Making. 3rd ed. SAGE PublicationsSage CA: Los Angeles, CA; 2013 Jun 26;33(5):679–91.