Clinicians need to be well informed about the level of evidence available for the wide array of nonhormonal management options currently available to midlife women to help prevent underuse of effective therapies or use of inappropriate or ineffective therapies. Recommended: Cognitive-behavioral therapy and, to a lesser extent, clinical hypnosis have been shown to be effective in reducing VMS. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS, although other selective serotonin reuptake/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine show evidence of efficacy. Recommend with caution: Some therapies that may be beneficial for alleviating VMS are weight loss, mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but additional studies of these therapies are warranted. Do not recommend at this time: There are negative, insufficient, or inconclusive data suggesting the following should not be recommended as proven therapies for managing VMS: cooling techniques, avoidance of triggers, exercise, yoga, paced respiration, relaxation, over-the-counter supplements and herbal therapies, acupuncture, calibration of neural oscillations, and chiropractic interventions. Incorporating the available evidence into clinical practice will help ensure that women receive evidence-based recommendations along with appropriate cautions for appropriate and timely management of VMS.

BackgroundHuman immunodeficiency virus (HIV) treatment side effects have a deleterious impact on treatment adherence, which is necessary to optimize treatment outcomes including morbidity and mortality.PurposeTo examine the effect of the Balance Project intervention, a five-session, individually delivered HIV treatment side effects coping skills intervention on antiretroviral medication adherence.MethodsHIV+ men and women (N = 249) on antiretroviral therapy (ART) with self-reported high levels of ART side effect distress were randomized to intervention or treatment as usual. The primary outcome was self-reported ART adherence as measured by a combined 3-day and 30-day adherence assessment.ResultsIntent-to-treat analyses revealed a significant difference in rates of nonadherence between intervention and control participants across the follow-up time points such that those in the intervention condition were less likely to report nonadherence. Secondary analyses revealed that intervention participants were more likely to seek information about side effects and social support in efforts to cope with side effects.ConclusionsInterventions focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects.

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Surveys in Europe and the United States indicate that only 10-20% of postmenopausal women are using hormones on a regular basis. Whereas the medical profession has strongly advocated for hormone replacement therapy (HRT), women are ambivalent about hormones after menopause. After 1 year, less than 40% of women who started HRT continue using their medications. Thirty percent never even get the prescription filled.Low rates of use are caused by a number of factors. In the United States, fear of breast cancer has been identified as the single most often cited reason for avoiding HRT. For many women, "hormone" is almost equated with "cancer causer." Assertions that breast cancers in HRT users are "better" cancers, ie, detected earlier, limited in stage, with much more favorable prognosis, do not reassure women. Women view breast cancer as a markedly disabling and disfiguring disease. Breast cancer is seen as a slow, long, lingering death, full of pain and suffering, with suffering increased and prolonged by surgery, radiation, chemotherapy, and other torments invented by the corporate medical pharmaceutical complex. Every women knows someone with breast cancer and has seen the effects on friends, colleagues, and relatives. This is an emotional experience that cannot be countered with the cold conclusions and calculations of statistics.Less threatening, but not less problematic, are the side effects of HRT, such as bleeding, weight gain, mood changes, cramping and abdominal pain, bloating, and headache. Bleeding, whether scheduled or unscheduled, is the most common reason for discontinuing HRT. Clearly, unscheduled bleeding resulting from HRT proves to be a nuisance and discourages many women from long-term use of combination hormones. This is further corroborated by the fact that the highest rates of hormone use are seen in women who have had a hysterectomy, rates commonly double those of women with intact uteri. Health professionals tend to downplay the degree of inconvenience caused by bleeding. Women, however, send a strong message: they do not like it, and they are not going to use it anymore (the bleeding and the hormones, respectively).In an effort to sidestep the side effects and long-term risks of HRT, women are searching for something else to use. Clearly, they recognize the potential health problems that