Management Of Menopause Research Articles

Menopause dynamics: From symptoms to quality of life, unraveling the complexities of the hormonal shift

The article delves deeply into the nature and process of menopause through which women undergo, which comprises profound transitions that occur during all menopausal stages. These findings emphasize the critical importance of comprehending and effectively addressing the diverse array of menopausal symptoms. The profound decline in progesterone and estrogen levels has been identified as the catalyst for triggering a spectrum of symptoms, which include but are not limited to hot flashes, mood swings, sleep disturbances, and genitourinary issues. These symptoms are noted to have a tangible impact on the daily functioning and overall well-being of women. This article underscores the pivotal role played by hormonal shifts in the manifestation of these symptoms and highlights the pressing need for the development of robust management strategies. Furthermore, hormone replacement therapy (HRT) is a well-researched treatment option, albeit with the caveat that its potential risks necessitate a personalized and nuanced approach. It also emphasizes the importance of lifestyle modifications, such as engaging in regular physical activity, adopting a balanced diet, and considering cognitive behavioral therapy, as pivotal elements in mitigating certain menopausal symptoms while concurrently enhancing overall health. The article also underscores the importance of addressing sexual health through therapeutic interventions, acknowledging their potential to significantly ameliorate vaginal symptoms and enhance sexual function, thereby fostering greater intimacy and relational satisfaction. Additionally, it highlights the profound psychosocial adjustments that women undergo during menopause, which are intrinsically intertwined with sociocultural factors. A holistic approach to menopause management is advised, which encompasses psychological support, medical treatments, and social interventions, underscoring their collective importance in effectively supporting women through this important life transition.

Beyond the Hot Flashes: Exploring the Holistic Approaches to Menopause Management – A Review

Beyond the Hot Flashes: Exploring the Holistic Approaches to Menopause Management – A Review

Prevalence of offering menopause hormone therapy among primary care doctors and its associated factors: A cross-sectional study.

Guidelines recommend Menopausal Hormone Therapy (MHT) as the most effective treatment for menopausal symptoms. However, a local study found that the usage of MHT among menopausal women was low (8.1%), with one of the main reasons being it is not recommended by doctors. Therefore, the objectives of this study are to determine the prevalence of offering MHT in treating symptomatic menopausal women among primary care doctors (PCDs) and its associated factors. This cross-sectional study involved PCDs from the Federal Territory of Kuala Lumpur, the Federal Territory of Putrajaya and the state of Selangor. All PCDs provided services in government primary care clinics from the three states were invited through the doctor in charge of each clinic. An online survey links was provided for the participants to the self-administered questionnaire. The questionnaire included PCDs' demographics, their menopause management practices, attitudes towards MHT, perceived barriers in offering MHT, knowledge of related guidelines and received training on menopause management. The outcome variable was offering MHT which defined as either prescription of MHT or referral to hospital for MHT initiation. Multivariate logistic regression analysis was performed to determine the factors associated with offering MHT. The response rate was 42.9% (559/1301). Of those who participated in the study, 77.8% of PCDs were female and 89.1% were medical officer. Although 66.9% of the participants reported offering MHT to their patients, the actual prescription rate was low (0.9%). Most PCDs (66%) would refer the patients to hospitals. 87.1% of PCDs (487/559) reported that MHT was not available in their clinic. In the past 12 months, 83% of PCDs had not received any related training. Female PCDs (AOR:2.5, CI: 1.51-4.13, p<0.001), perceiving MHT as preference treatment for menopause symptom (AOR:3.6, CI: 2.13-6.19, p < 0.001), having likelihood to recommend MHT to family and friends (AOR:3.0, CI: 1.87-4.83, p < 0.001), and receiving training on menopause management (AOR:2.7, CI: 1.30-5.56, p = 0.008) were the positive predictor of offering MHT. The negative predictors in offering MHT were no-experience in prescribing MHT (AOR: 0.4, CI: 0.15-0.87, p = 0.024) and lack of information regarding MHT for the patient (AOR: 0.4, CI:0.20-0.67, p < 0.001). The study revealed a low rate of MHT prescription among PCDs, with many relying on referrals to hospitals for managing menopausal symptoms. The findings underscore the need for strategies that includes fulfilling professional training gaps, improving MHT availability, and improving information dissemination for patient.

Homoeopathic Management of Menopause: A Comprehensive Review

Background: Menopause signifies a crucial physiological shift in a woman's journey, denoting the halt of menstrual cycles caused by the gradual decline in ovarian activity. Conventional management options, such as Hormone Replacement Therapy (HRT), are effective but not devoid of risks and limitations. In contrast, homeopathy offers a holistic approach to symptom management, aiming to address the underlying cause of menopausal disturbances. Aim and Objective: By critically analyzing clinical studies, randomized controlled trials, and observational research, this paper seeks to elucidate the role of homeopathy as an alternative and complementary therapy for menopause. The objective is to provide insights into the potential benefits of homeopathy and contribute to the growing body of evidence supporting its use in menopausal care. Methodology: A comprehensive search strategy was done to identify relevant literatures from databases such as PubMed, SCOPUS, and Google Scholar. The selection of eligible studies was conducted according to predefined criteria for inclusion and exclusion. Results: Our findings resulted into nine studies that fulfilled the inclusion criteria, including randomized controlled trials, observational studies, and clinical trials. These studies collectively provided evidence of the efficacy of homeopathic medicines in managing various menopausal symptoms, including hot flushes, mood swings, and sleep disturbances. Conclusion: The reviewed literature suggests that homeopathy offers a promising avenue for managing menopausal symptoms, providing an alternative or complimentary approach to conventional therapies. Individualized treatment strategies tailored to each woman's unique symptomatology appear particularly beneficial. However, further clinical trials are needed to fully elucidate the efficacy and mechanisms of action of homeopathic interventions in menopausal care.

Women living with HIV: identifying and managing their menopause, age-related, and psychosocial health needs in a metropolitan sexual health service in Sydney, Australia.

Background Aging women living with HIV are significantly affected by menopause and comorbidities, yet international and Australian HIV guidance on the management of women is scarce. This study aimed to identify gaps in clinical management of menopause, age-related comorbidities, and psychosocial health of women living with HIV attending our metropolitan sexual health service. Methods A clinical audit of all cisgender women who attended Sydney Local Health District Department of Sexual Health Medicine for ongoing routine HIV care between 1 January 2021 and 1 January 2023 was undertaken. Results Twenty-seven patient files were examined. Half (13/27, 48.1%) of women were age 45years and older, of whom 6/13 (46.2%) were postmenopausal and 4/13 (30.8%) did not have menopause status recorded. In the prior 12months, most women had their blood pressure (19/27, 70.4%), total cholesterol (21/27, 77.8%), glycated haemoglobin (21/27, 77.8%), estimated glomerular filtration rate (27/27, 96.3%), and liver function tests (26/27, 96.3%) measured. Smoking and alcohol intake was documented for less than half of women (13/27, 48.1%; and 12/27, 44.4%; respectively). In women aged 45years and older, absolute cardiovascular disease risk was calculated in 2/13 (15.4%), and none had a Fracture Risk Assessment Tool score or cognitive screen performed in the prior 12months. One-fifth (5/27, 18.5%) had a documented history of depression or anxiety. Of those screened, half (4/8, 50.0%) disclosed past intimate partner violence. Conclusions Our service has now implemented a reference tool to guide routine monitoring of women living with HIV, with sections dedicated to reproductive health and psychological wellbeing. Australian HIV management guidelines would benefit from specific guidance for women.

Willingness to use clinical scales for menopause management among general practitioners

Objectives The use of digital healthcare technologies to enhance healthcare delivery has seen significant growth. However, a notable a notable research gap exists in the application of clinical scales for menopause management by general practitioners (GPs). This study aims to investigate willingness of GPs to use specific menopausal scale tools in the care of females for menopause management. Method An anonymous online survey was developed, which received responses from 348 French GPs in 2023. Multiple backward logistic regression was performed to identify the factors influencing the willingness to use a practical menopause management scale. Results In total, 87.93% of GPs are not familiar with the Greene Climacteric Scale and 90.52% are not familiar with the Menopause Quick 6 scale. In contrast, 90.52% would be interested in having access to such scales. The willingness to use a menopause management scale is associated with caring for menopausal females (odds ratio [OR] = 6.13, 95% confidence interval [CI] [2.08–18.08], p = 0.001), less experience (OR = 7.10, 95% CI [2.05–25.22], p = 0.002), the importance of health prevention in daily practice (comparing ‘very important’ to ‘not’, OR = 12.98, 95% CI [1.68–97.60], p = 0.004) and the use of a digital scale in daily practice for menopausal management (OR = 2.13, 95% CI [1.04–5.83], p = 0.014). Conclusion Future research is essential in representative population to confirm these findings in menopause management.

Labour Law’s (Mis)Management of Menopausal Workers

AbstractAt the core of this paper is a critique of labour law’s engagement with menopausal workers in the UK. The critique is framed by an overarching discussion of the coping strategies adopted when lived realities of menopausal workers disrupt traditional organisational cultures, especially its manifestation in the ‘ideal worker’ norm. At the core of the paper is an argument that the legal treatment of menopausal workers is failing to encourage effective management of menopause / workplace tensions and, as a result, validates the promotion of this problematic ‘ideal worker’ norm within organisational cultures. Effective labour laws could however better support menopausal workers: labour laws could encourage long term individual and organisational resilience by adopting more effective anti-discrimination and dismissal protections and more strongly centring negotiation as a realistic strategy for menopausal workers and employers when navigating any tensions that arise.

A New Era in Menopause Management?

A New Era in Menopause Management?

Factors affecting shared decision-making concerning menopausal hormone therapy.

Menopausal hormone therapy (MHT) is an effective treatment for menopause-related symptoms. Menopause management guidelines recommend a personalized approach to menopause care, including MHT use. Decision-making around menopause care is a complex, iterative process influenced by multiple factors framed by perspectives from both women and healthcare providers (HCPs). This narrative review aims to summarize evidence around factors affecting decision-making regarding menopause-related care. For HCPs, the provision of individualized risk estimates is challenging in practice given the number of potential benefits and risks to consider, and the complexity of the data available, especially within time-limited consultations. Women seeking menopause care have the difficult task of making sense of the benefit versus risk profiles to make choices in line with their decisional needs influenced by sociocultural/economic, educational, demographic, and personal characteristics. The press, social media, and influential celebrities also impact the perception of menopause and decision-making around it. Understanding these factors can lead to improved participation in shared decision-making, satisfaction with the decision and decision-making process, adherence to treatment, reduced decisional regret, efficient use of resources, and ultimately long-term satisfaction with care.

(071) IMPROVING TRAINEE COMFORT IN ASSESSMENT AND MANAGEMENT OF FEMALE SEXUAL HEALTH AND MENOPAUSE THROUGH AN INTERACTIVE WORKSHOP

Abstract Introduction Concerns related to female sexual health and menopause are common in clinical practice, but these topics are often inadequately covered during training. Many medical schools and residency programs lack a formal curriculum, and trainees in internal medicine, family medicine, and obstetrics and gynecology often graduate feeling uncertain in their management of these conditions. Objective Improve resident comfort with assessment and management of female sexual health and menopause through an interactive workshop. Methods We created a 90-minute, interactive workshop focused on female sexual health and menopause. Residents in internal medicine at a large academic medical center were invited to participate. A multidisciplinary group including physicians, advanced practice providers, registered nurses and a certified sex therapist were recruited to lead the workshop. Results Participants rotate through three 30-minute sessions targeted to learning objectives. One session focuses on conducting a symptom-based pelvic exam. A 3-dimensional model is used to review the anatomy of the female pelvic floor and demonstrate physical exam techniques to evaluate vaginal and vulvar symptoms, pelvic pain, and dyspareunia. Diagnostic skills include vulvar inspection to assess for skin and mucosal changes, cotton swab test of the vestibule, and assessment of pelvic floor musculature. A second session focuses on the genitourinary syndrome of menopause (GSM). The pathophysiology, presentation and treatment of GSM is introduced. Next, registered nurses with expertise in female sexual health and menopause lead an interactive demonstration of vaginal moisturizers and lubricants. Advice for counseling patients on the proper use and application of vaginal estrogens is also reviewed. The final session focuses on sexual health counseling, including sexual history-taking skills. Participants are taught about the domains of sexual function, female sexual response cycle, types of desire, patient resources, and sexual aids. Feedback following the initial iteration of this workshop was very positive. All participants felt that the experience was an effective use of time, would recommend it to others, and were confident in their ability to apply skills to their clinical practice. Conclusions This interactive workshop led by a multidisciplinary group of providers aims to improve trainee comfort in evaluation and management of female sexual health and menopause. Given the commonplace nature of these topics in primary care and paucity of existing curricula, consideration could be given to the inclusion of a similar educational experience into internal medicine, family medicine and/or obstetrics and gynecology residency programs. Disclosure No.

Management of menopause in women with a history of endometriosis.

Due to increasing life expectancy, women spend a significant part of their lives in menopause. Women with a history of endometriosis are more likely to become menopausal at an early age due to bilateral oophorectomy or repeated ovarian surgery. In addition, some medical therapies used for endometriosis, such as gonadotropin releasing hormone agonists or progestins reduce bone mineral density. Furthermore, women with endometriosis have a higher background risk of cardiovascular disorders and hypercholesterolemia. Hence, it is important to recommend the use of hormone replacement therapy (HRT) to these women when they become menopausal, at least until the age of natural menopause. Although based on limited data, there is a possibility of reactivation of symptoms of endometriosis or its lesions, and a theoretical possibility of malignant transformation, although this remains unproven. Therefore, women should be advised in the light of this information before starting HRT after the age of natural menopause and are asked to seek help if they experience symptoms that may indicate these changes. Estrogen only HRT should be avoided and combined HRT preparations should be recommended, even after a hysterectomy.

Management of unscheduled bleeding on HRT: A joint guideline on behalf of the British Menopause Society, Royal College Obstetricians and Gynaecologists, British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Faculty of Sexual and Reproductive Health, Royal College of General Practitioners and Getting it Right First Time.

Unscheduled bleeding on hormone replacement therapy (HRT) can affect up to 40% of users. In parallel with the increase in HRT prescribing in the UK, there has been an associated increase in referrals to the urgent suspicion of cancer pathway for unscheduled bleeding. On behalf of the British Menopause Society (BMS) an expert review panel was established, including primary and secondary care clinicians with expertise in the management of menopause, with representatives from key related organisations, including the Royal College of Obstetricians & Gynaecologists, the British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Royal College of General Practitioners and Faculty of Sexual and Reproductive Health, and service development partners from NHS England and GIRFT (Getting it Right First Time). For each topic, a focused literature review was completed to develop evidence led recommendations, where available, which were ratified by consensus review within the panel and by guideline groups.

A rapid review of menopausal education programmes.

Menopause is a significant life event that can impact a woman's quality of life and mental health due to hormonal changes. Menopause education programmes play a crucial role in increasing awareness and knowledge about menopause in women. This rapid review aimed to identify the structure and components of menopause education programmes and summarise the evidence of their effectiveness in improving menopausal knowledge, symptoms, and quality of life. The Cochrane rapid review methodology was employed, involving systematic searches in four databases. The eligibility criteria included primary research on menopause education programmes for adults, and studies reporting menopause-related outcomes. A total of 39 studies were included in the review, with most (n = 26/39, 66.7%) published in the last decade. The majority of interventions were delivered in group settings, providing advantages such as a supportive environment and shared experiences among participants. The most frequently covered topics included signs and symptoms of menopause, treatment/management, and lifestyle factors. The review identified evidence of effectiveness in supporting menopause education programmes for improving women's knowledge, symptoms, and quality of life. However, inconsistent reporting of intervention components hindered replication and implementation. The review suggests the need for comprehensive reporting of interventions, and inclusion of premenopausal women, and recommends that future menopause education interventions are inclusive for all ages and abilities. Overall, studies included in this review support the use of menopause education programmes for improving women's understanding and management of menopause.

Abstract PO4-10-11: Needs of oncology nurse navigators serving young or metastatic breast cancer patients

Abstract Oncology nurse navigators (ONN) facilitate breast cancer patients' care via information, resources, and referral services. Two important groups of breast cancer patients served by ONN are young women with breast cancer (yBC), defined as women diagnosed at age 45 or younger, and metastatic breast cancer (mBC) patients. These two groups of patients have distinct needs for clinical care and services. To better understand the needs and experiences of ONN serving these patients, we surveyed 52 active ONN in the United States via an online needs assessment survey about their familiarity with topics relevant for breast cancer patients, referral patterns, and perception of educational needs. As expected, most ONNs saw more yBC than mBC patients. Familiarity of ONN with topics relevant for yBC and mBC differed based on their work experience. For some topics, earlier-career ONN (&amp;lt;5 years of work experience) reported distinct experiences from later-career ONN (more than 5 years of work experience). Earlier-career ONN were less familiar than later-career ONN with clinical trial participation (45% vs 79%; p=0.0315) and genetic counseling and testing (73% vs 96%; p=0.0431). Most ONN referred yBC and mBC patients for financial, mental health, or genetic testing services. For many other services, referral patterns of yBC and mBC patients differed. Earlier-career ONN referred patients less often than later-career ONN to clinical trials (35% vs 89%; p=.0014 for yBC, and 36% vs 89%, p=.0028 for mBC). Earlier-career ONN tended to refer mBC patients less often than yBC for genetic counseling and testing, healthy lifestyles, menopause management, and sexual health or intimacy services. In contrast, later-career ONN referred yBC and mBC patients at similar rates. ONN reported substantial barriers to many services (but not to fatigue, menopause management, and pain management). The services for which ONN most frequently reported barriers were fertility preservation (predominantly financial and lack of programs/providers) and clinical trial services (patient understanding of value and medical jargon/health literacy barriers). ONN referred patients infrequently to some services despite reporting few barriers in contrast to prior reports of breast cancer patients' needs. Most ONN were interested in continuing education for sexual health and intimacy but not clinical trials, treatment side effects, or pain management. Most ONN cited a need for patient materials about sexual health and intimacy and mental health issues. While most ONN were confident in their ability to address questions about breast cancer in the media, they indicated additional resources would be useful. Understanding barriers to information and referrals is necessary to develop approaches to reduce educational gaps and lower referral barriers. Adapting efforts according to ONN career stage may be an important component for continuing education. For clinical trial participation, patient-friendly materials may help reduce barriers to referral and participation. Citation Format: Kelly Owens, Marleah Dean, Elizabeth Bourquardez Clark, Piri Welcsh, Diane Rose, Erica Kuhn, Jessica Conaty, Robin Pugh-Yi, Susan Friedman. Needs of oncology nurse navigators serving young or metastatic breast cancer patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-10-11.

Evidence-based management of menopause.

Evidence-based management of menopause.

Type 1 diabetes and menopause, what women would like to know: a public and patient involvement exercise

Introduction: Managing the impacts of the menopause can be a tedious experience for many women, and when coupled with diabetes, the challenges are multiplied. Literature searches confirm a dearth of information and support to help women with these dual conditions. Methods: A Patient Public Involvement exercise involving an online survey disseminated electronically via social media amongst the Type 1 diabetes online community. It comprised five closed questions and one open question to elicit priority needs. The survey was supplemented with a subsequent Twitter chat. The paper conforms to the guidance for reporting of patient and public involvement in health and social care research (GRIPP). Results: Of the 184 women who completed the survey across the United Kingdom, most were aged between 40 and 59 years (n = 167, 90.8%). Although 137 (72.8%) women reported that menopause had impacted on their diabetes, only a minority (n = 50, 27.2%) indicated that it had ever been discussed with them. The overarching theme from the open question was of an overall Lack of awareness about the impacts of menopause, with the following subthemes: 1) Need for information about menopause, 2) An additional burden, 3) Symptoms of diabetes or menopause? and 4) Communication – expectations of care. Conclusions: Women need information, support and guidance during this phase of life. This oft overlooked aspect of care is engendering frustration and suboptimal diabetes management and will be a topic raised with increasing frequency in general practice and diabetes specialities. The management of diabetes and menopause deserves more attention across the diabetes community.

Needs assessment study for management of menopause in the community.

To study the symptoms of menopause and perception of women in relation to menopause in order to understand their needs. A cross-sectional, multi-centric study was undertaken at three institutions (called DH, SJ, and SK) at two cities in India. The study population comprised women between the ages of 40 and 60. Institutional Ethics Committee approval and consent of participants were ensured. Two instruments, a pilot-tested, peer-reviewed, validated, structured questionnaire and the Menopause Rating Scale (MRS) were utilized for the study. The minimum sample size was calculated to be 385 per site. Statistical analysis was conducted using the IBM Statistical Package for Social Sciences. A total of 1297 forms were analyzed. MRS scores showed psychological symptoms to be most prevalent. Joint and muscular pains were the most common somatic symptoms. Hot flashes and urogenital symptoms were experienced by a lower number. Our MRS scores were significantly higher than those seen in other regions. Urban women, site SJ, those with irregular menstrual cycles, and lower incomes scored higher than their counterparts. Awareness about menopause was patchy, especially regarding medication or support services available. The high MRS scores emphasize the need to institute awareness programs, providing information on choices available for care (hormone replacement therapy, medications, or counseling) and information on where to access services. Primary care physicians can play a vital role in fulfilling this need by ensuring timely knowledge to the community, providing correct diagnosis and treatment. This will help improve the quality of life and sense of well-being of this community.

Effects of a therapeutic lifestyle modification intervention on cardiometabolic health, sexual functioning and health-related quality of life in perimenopausal Chinese women: protocol for a randomised controlled trial

IntroductionPerimenopause is a critical transitional period in reproductive ageing. A set of physiological and psychological changes can affect perimenopausal women’s quality of life and further threaten their older adult health...

A Contemporary View of Menopausal Hormone Therapy.

Enthusiasm for the use of hormones to ameliorate symptoms of perimenopause and menopause has waxed and waned over the years. Both treatment for symptoms and training of women's health care practitioners in the management of menopause have sharply declined since publication of the Women's Health Initiative initial results in 2002. Findings from that trial, which treated a population of older, asymptomatic patients, have been extrapolated over the past 21 years to all estrogen products, all menopausal women, and all delivery mechanisms. Our patients deserve a more nuanced, individualized approach. Conjugated equine estrogens and medroxyprogesterone acetate are no longer the predominant medications or medications of choice available for management of menopausal symptoms. All hormones are not equivalent any more than all antiseizure medications or all antihypertensives are equivalent; they have different pharmacodynamics, duration of action, and affinity for receptors, among other things, all of which translate to different risks and benefits. Consideration of treatment with the right formulation, at the right dose and time, and for the right patient will allow us to recommend safe, effective, and appropriate treatment for people with menopausal symptoms.

Multimodal, Technology-Assisted Intervention for the Management of Menopause after Cancer Improves Cancer-Related Quality of Life-Results from the Menopause after Cancer (Mac) Study.

Vasomotor symptoms (VMSs) associated with menopause represent a significant challenge for many patients after cancer treatment, particularly if conventional menopausal hormone therapy (MHT) is contraindicated. The Menopause after Cancer (MAC) Study (NCT04766229) was a single-arm phase II trial examining the impact of a composite intervention consisting of (1) the use of non-hormonal pharmacotherapy to manage VMS, (2) digital cognitive behavioral therapy for insomnia (dCBT-I) using Sleepio (Big Health), (3) self-management strategies for VMS delivered via the myPatientSpace mobile application and (4) nomination of an additional support person/partner on quality of life (QoL) in women with moderate-to-severe VMS after cancer. The primary outcome was a change in cancer-specific global QoL assessed by the EORTC QLC C-30 v3 at 6 months. Secondary outcomes included the frequency of VMS, the bother/interference of VMS and insomnia symptoms. In total, 204 women (82% previous breast cancer) with a median age of 49 years (range 28-66) were recruited. A total of 120 women completed the protocol. Global QoL scores increased from 62.2 (95%CI 58.6-65.4) to 70.4 (95%CI 67.1-73.8) at 6 months (p < 0.001) in the intention to treatment (ITT) cohort (n = 204) and from 62 (95%CI 58.6-65.4) to 70.4 (95%CI 67.1-73.8) at 6 months (p < 0.001) in the per-protocol (PP) cohort (n = 120). At least 50% reductions were noticed in the frequency of VMS as well as the degree of bother/interference of VMS at six months. The prevalence of insomnia reduced from 93.1% at the baseline to 45.2% at 6 months (p < 0.001). The Sleep Condition Indicator increased from 8.5 (SEM 0.4) to 17.3 (SEM 0.5) (p < 0.0005) in the ITT cohort and 7.9 (SEM 0.4) to 17.3 (SEM 0.5) (p < 0.001) in the PP cohort. A targeted composite intervention improves the quality of life for cancer patients with frequent and bothersome vasomotor symptoms with additional benefits on frequency, the bother/interference of VMS and insomnia symptoms.