State of the Science: Hot Flashes and Cancer, Part 2: Management and Future Directions

Adlercreutz, H. (1990). Western diet and Western diseases: Some hormonal and biochemical mechanisms and associations. Scandinavian Journal of Clinical and Laboratory Investigation, 201(1, Suppl.), 3-23.

Adlercreutz, H., & Mazur, W. (1997). Phyto-oestrogens and Western diseases. Annals of Medicine, 29, 95-120.

Aiello, E.J., Yasui, Y., Tworoger, S.S., Ulrich, C.M., Irwin, M.L., Bowen, D., et al. (2004). Effect of a yearlong, moderate-intensity exercise intervention on the occurrence and severity of menopause symptoms in postmenopausal women. Menopause, 11, 382-388.

Albertazzi, P., Pansini, F., Bonaccorsi, G., Zanotti, L., Forini, E., & De Aloysio, D. (1998). The effect of dietary soy supplementation on hot flushes. Obstetrics and Gynecology, 91, 6-11.

Barton, D., La, V.B., Loprinzi, C., Novotny, P., Wilwerding, M.B., & Sloan, J. (2002). Venlafaxine for the control of hot flashes: Results of a longitudinal continuation study. Oncology Nursing Forum, 29, 33-40.

Barton, D., & Loprinzi, C.L. (2004). Making sense of the evidence regarding nonhormonal treatments for hot flashes. Clinical Journal of Oncology Nursing, 8, 39-42.

Barton, D.L., Loprinzi, C., & Gostout, B. (2002). Current management of menopausal symptoms in cancer patients. Oncology, 16, 67-72, 74.

Barton, D.L., Loprinzi, C.L., Novotny, P., Shanafelt, T., Sloan, J., Wahner-Roedler, D., et al. (2003). Pilot evaluation of citalopram for the relief of hot flashes. Journal of Supportive Oncology, 1, 47-51.

Barton, D.L., Loprinzi, C.L., Quella, S.K., Sloan, J.A., Veeder, M.H., Egner, J.R., et al. (1998). Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. Journal of Clinical Oncology, 16, 495-500.

Beique, J.C., de Montigny, C., Blier, P., & Debonnel, G. (1999). Venlafaxine: Discrepancy between in vivo 5-HT and NE reuptake blockade and affinity for reuptake sites. Synapse, 32, 198-211.

Bergmans, M.G., Merkus, J.M., Corbey, R.S., Schellekens, L.A., & Ubachs, J.M. (1987). Effect of bellergal retard on climacteric complaints: A double-blind, placebo-controlled study. Maturitas, 9, 227-234.

Bertelli, G., Venturini, M., Del Mastro, L., Bergaglio, M., Sismondi, P., Biglia, N., et al. (2002). Intramuscular depot medroxyprogesterone versus oral megestrol for the control of postmenopausal hot flashes in breast cancer patients: A randomized study. Annals of Oncology, 13, 883-888.

Burdette, J.E., Liu, J., Chen, S.N., Fabricant, D.S., Piersen, C.E., Barker, E.L., et al. (2003). Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor. Journal of Agricultural and Food Chemistry, 51, 5661-5670.

Carpenter, J.S. (2000). Hot flashes and their management in breast cancer. Seminars in Oncology Nursing, 16, 214-225.

Carpenter, J.S., Andrykowski, M.A., Freedman, R.R., & Munn, R. (1999). Feasibility and psychometrics of an ambulatory hot flash monitoring device. Menopause, 6, 209-215.

Carpenter, J.S., Azzouz, F., Monahan, P.O., Storniolo, A.M., & Ridner, S.H. (In press). Is sternal skin conductance monitoring a valid measure of hot flash intensity and/or hot flash distress? Menopause, 12(5).

Carpenter, J.S., Gilchrist, J.M., Chen, K., Gautam, S., & Freedman, R.R. (2004). Hot flashes, core body temperature, and metabolic parameters in breast cancer survivors. Menopause, 11, 375-381.

Carpenter, J.S., Johnson, D., Wagner, L., & Andrykowski, M. (2002). Hot flashes and related outcomes in breast cancer survivors and matched comparison women. Oncology Nursing Forum, 29, E16-E25.

Carpenter, J.S., Monahan, P.O., & Azzouz, F. (2004). Accuracy of subjective hot flush reports compared with continuous sternal skin conductance monitoring. Obstetrics and Gynecology, 104, 1322-1326.

Carpenter, J.S., & Ridner, S.H. (2003). Peer Viewpoint: Commentary on "New therapeutic approaches for hot flashes in women." Journal of Supportive Oncology, 1, 14-15.

Carpenter, J.S., Wells, N., Lambert, B., Watson, P., Slayton, T., Chak, B., et al. (2002). A pilot study of magnetic therapy for hot flashes after breast cancer. Cancer Nursing, 25, 104-109.

Cauley, J.A., Robbins, J., Chen, Z., Cummings, S.R., Jackson, R.D., LaCroix, A.Z., et al. (2003). Effects of estrogen plus progestin on risk of fracture and bone mineral density: The Women's Health Initiative randomized trial. JAMA, 290, 1729-1738.

Chlebowski, R.T., Hendrix, S.L., Langer, R.D., Stefanick, M.L., Gass, M., Lane, D., et al. (2003). Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: The Women's Health Initiative Randomized Trial. JAMA, 289, 3243-3253.

Chlebowski, R.T., Wactawski-Wende, J., Ritenbaugh, C., Hubbell, F.A., Ascensao, J., Rodabough, R.J., et al. (2004). Estrogen plus progestin and colorectal cancer in postmenopausal women. New England Journal of Medicine, 350, 991-1004.

Christy, C.J. (1945). Vitamin E in menopause. American Journal of Obstetrics and Gynecology, 50, 84-87.

Clemons, M., Clamp, A., & Anderson, B. (2002). Management of the menopause in cancer survivors. Cancer Treatment Reviews, 28, 321-333.

Clover, A., & Ratsey, D. (2002). Homeopathic treatment of hot flushes: A pilot study. Homeopathy, 91, 75-79.

Cohen, S.M., O'Connor, A.M., Hart, J., Merel, N.H., & Te, H.S. (2004). Autoimmune hepatitis associated with the use of black cohosh: A case study. Menopause, 11, 575-577.

Cohen, S.M., Rousseau, M.E., & Carey, B.L. (2003). Can acupuncture ease the symptoms of menopause? Holistic Nursing Practice, 17, 295-299.

Cushman, M., Kuller, L.H., Prentice, R., Rodabough, R.J., Psaty, B.M., Stafford, R.S., et al. (2004). Estrogen plus progestin and risk of venous thrombosis. JAMA, 292, 1573-1580.

Dong, H., Ludicke, F., Comte, I., Campana, A., Graff, P., & Bischof, P. (2001). An exploratory pilot study of acupuncture on the quality of life and reproductive hormone secretion in menopausal women. Journal of Alternative and Complementary Medicine, 7, 651-658.

Einbond, L.S., Shimizu, M., Xiao, D., Nuntanakorn, P., Lim, J.T., Suzui, M., et al. (2004). Growth inhibitory activity of extracts and purified components of black cohosh on human breast cancer cells. Breast Cancer Research and Treatment, 83, 221-231.

Finkler, R.S. (1949). The effect of vitamin E in the menopause. Journal of Clinical Endocrinology and Metabolism, 9(1), 89-94.

Freedman, R.R. (1989). Laboratory and ambulatory monitoring of menopausal hot flashes. Psychophysiology, 26, 573-579.

Freedman, R.R., & Krell, W. (1999). Reduced thermoregulatory null zone in postmenopausal women with hot flashes. American Journal of Obstetrics and Gynecology, 181, 66-70.

Freedman, R.R., & Woodward, S. (1992). Behavioral treatment of menopausal hot flushes: Evaluation by ambulatory monitoring. American Journal of Obstetrics and Gynecology, 167, 436-439.

Ganz, P.A., Greendale, G.A., Petersen, L., Zibecchi, L., Kahn, B., & Belin, T.R. (2000). Managing menopausal symptoms in breast cancer survivors: Results of a randomized controlled trial. Journal of the National Cancer Institute, 92, 1054-1064.

Germaine, L.M., & Freedman, R.R. (1984). Behavioral treatment of menopausal hot flashes: Evaluation by objective methods. Journal of Consulting and Clinical Psychology, 52, 1072-1079.

Goldberg, R.M., Loprinzi, C.L., O'Fallon, J.R., Veeder, M.H., Miser, A.W., Mailliard, J.A., et al. (1994). Transdermal clonidine for ameliorating tamoxifen-induced hot flashes. Journal of Clinical Oncology, 12, 155-158.

Grady-Weliky, T.A., & Hartmann, D.M. (2001). Flushing in a menopausal woman taking venlafaxine. American Journal of Psychiatry, 158, 1330.

Guttuso, T., Jr., Kurlan, R., McDermott, M.P., & Kieburtz, K. (2003). Gabapentin's effects on hot flashes in postmenopausal women: A randomized controlled trial. Obstetrics and Gynecology, 101, 337-345.

Guttuso, T.J., Jr. (2000). Gabapentin's effects on hot flashes and hypothermia. Neurology, 54, 2161-2163.

Hammar, M., Frisk, J., Grimas, O., Hook, M., Spetz, A.C., & Wyon, Y. (1999). Acupuncture treatment of vasomotor symptoms in men with prostatic carcinoma: A pilot study. Journal of Urology, 161, 853-856.

Harris, P.F., Remington, P.L., Trentham-Dietz, A., Allen, C.I., & Newcomb, P.A. (2002). Prevalence and treatment of menopausal symptoms among breast cancer survivors. Journal of Pain and Symptom Management, 23, 501-509.

Hiemke, C., & Hartter, S. (2000). Pharmacokinetics of selective serotonin reuptake inhibitors. Pharmacology and Therapeutics, 85, 11-28.

Hoda, D., Perez, D.G., & Loprinzi, C.L. (2003). Hot flashes in breast cancer survivors. Breast Journal, 9, 431-438.

Holzbeierlein, J.M., Castle, E., & Thrasher, J.B. (2004). Complications of androgen deprivation therapy: Prevention and treatment. Oncology, 18, 303-309.

Horst, W.D., & Preskorn, S.H. (1998). Mechanisms of action and clinical characteristics of three atypical antidepressants: Venlafaxine, nefazodone, bupropion. Journal of Affective Disorders, 51, 237-254.

Hostanska, K., Nisslein, T., Freudenstein, J., Reichling, J., & Saller, R. (2004). Cimicifuga racemosa extract inhibits proliferation of estrogen receptor-positive and negative human breast carcinoma cell lines by induction of apoptosis. Breast Cancer Research and Treatment, 84, 151-160.

Irvin, J.H., Domar, A.D., Clark, C., Zuttermeister, P.C., & Friedman, R. (1996). The effects of relaxation response training on menopausal symptoms. Journal of Psychosomatic Obstetrics and Gynaecology, 17, 202-207.

Jacobson, J.S., Troxel, A.B., Evans, J., Klaus, L., Vahdat, L., Kinne, D., et al. (2001). Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. Journal of Clinical Oncology, 19, 2739-2745.

Jeffery, S.M., Pepe, J.J., Popovich, L.M., & Vitagliano, G. (2002). Gabapentin for hot flashes in prostate cancer. Annals of Pharmacotherapy, 36, 433-436.

Jin, Y., Desta, Z., Stearns, V., Ward, B., Ho, H., Lee, K.H., et al. (2005). CYP2D6 genotype, antidepressant use, and tamoxifen metabolism during adjuvant breast cancer treatment. Journal of the National Cancer Institute, 97, 30-39.

Jubelirer, S.J. (1995). The management of menopausal symptoms in women with breast cancer. West Virginia Medical Journal, 91, 54-56.

Knight, D.C., Howes, J.B., Eden, J.A., & Howes, L.G. (2001). Effects on menopausal symptoms and acceptability of isoflavone-containing soy powder dietary supplementation. Climacteric, 4, 13-18.

Kockler, D.R., & McCarthy, M.W. (2004). Antidepressants as a treatment for hot flashes in women. American Journal of Health-System Pharmacy, 61, 287-292.

Kronenberg, F. (1990). Hot flashes: Epidemiology and physiology. Annals of the New York Academy of Sciences, 592, 52-86.

Lindh-Astrand, L., Nedstrand, E., Wyon, Y., & Hammar, M. (2004). Vasomotor symptoms and quality of life in previously sedentary postmenopausal women randomised to physical activity or estrogen therapy. Maturitas, 48, 97-105.

Liske, E., Hanggi, W., Henneicke-von Zepelin, H.H., Boblitz, N., Wustenberg, P., & Rahlfs, V.W. (2002). Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): A 6-month clinical study demonstrates no systemic estrogenic effect. Journal of Women's Health and Gender-Based Medicine, 11, 163-174.

Lontos, S., Jones, R.M., Angus, P.W., & Gow, P.J. (2003). Acute liver failure associated with the use of herbal preparations containing black cohosh. Medical Journal of Australia, 179, 390-391.

Loprinzi, C.L., Barton, D.L., Carpenter, L.A., Sloan, J.A., Novotny, P.J., Gettman, M.T., et al. (2004). Pilot evaluation of paroxetine for treating hot flashes in men. Mayo Clinic Proceedings, 79, 1247-1251.

Loprinzi, C.L., Goldberg, R.M., O'Fallon, J.R., Quella, S.K., Miser, A.W., Mynderse, L.A., et al. (1994). Transdermal clonidine for ameliorating post-orchiectomy hot flashes. Journal of Urology, 151, 634-636.

Loprinzi, C.L., Kugler, J.W., Sloan, J.A., Mailliard, J.A., LaVasseur, B.I., Barton, D.L., et al. (2000). Venlafaxine in management of hot flashes in survivors of breast cancer: A randomised controlled trial. Lancet, 356, 2059-2063.

Loprinzi, C.L., Michalak, J.C., Quella, S.K., O'Fallon, J.R., Hatfield, A.K., Nelimark, R.A., et al. (1994). Megestrol acetate for the prevention of hot flashes. New England Journal of Medicine, 331, 347-352.

Loprinzi, C.L., Pisansky, T.M., Fonseca, R., Sloan, J.A., Zahasky, K.M., Quella, S.K., et al. (1998). Pilot evaluation of venlafaxine hydrochloride for the therapy of hot flashes in cancer survivors. Journal of Clinical Oncology, 16, 2377-2381.

Loprinzi, C.L., Sloan, J.A., Perez, E.A., Quella, S.K., Stella, P.J., Mailliard, J.A., et al. (2002). Phase III evaluation of fluoxetine for treatment of hot flashes. Journal of Clinical Oncology, 20, 1578-1583.

Mansky, P.J., & Straus, S.E. (2002). St. John's wort: More implications for cancer patients. Journal of the National Cancer Institute, 94, 1187-1188.

Manson, J.E., Hsia, J., Johnson, K.C., Rossouw, J.E., Assaf, A.R., Lasser, N.L., et al. (2003). Estrogen plus progestin and the risk of coronary heart disease. New England Journal of Medicine, 349, 523-534.

McLaren, H.C. (1949). Vitamin E in the menopause. BMJ, 2, 1378-1381.

Messina, M., & Barnes, S. (1991). The role of soy products in reducing risk of cancer. Journal of the National Cancer Institute, 83, 541-546.

Miller, K.L. (1992). Alternatives to estrogen for menopausal symptoms. Clinical Obstetrics and Gynecology, 35, 884-893.

Moyad, M.A. (2002). Complementary/alternative therapies for reducing hot flashes in prostate cancer patients: Reevaluating the existing indirect data from studies of breast cancer and postmenopausal women. Urology, 59(4, Suppl. 1), 20-33.

Murkies, A.L., Lombard, C., Strauss, B.J., Wilcox, G., Burger, H.G., & Morton, M.S. (1995). Dietary flour supplementation decreases post-menopausal hot flushes: Effect of soy and wheat. Maturitas, 21, 189-195.

Nagamani, M., Kelver, M.E., & Smith, E.R. (1987). Treatment of menopausal hot flashes with transdermal administration of clonidine. American Journal of Obstetrics and Gynecology, 156, 561-565.

Nagata, C., Takatsuka, N., Kawakami, N., & Shimizu, H. (2001). Soy product intake and hot flashes in Japanese women: Results from a community-based prospective study. American Journal of Epidemiology, 153, 790-793.

North American Menopause Society. (2004). Treatment of menopause-associated vasomotor symptoms: Position statement of the North American Menopause Society. Menopause, 11, 11-33.

Pandya, K.J., Thummala, A.R., Griggs, J.J., Rosenblatt, J.D., Sahasrabudhe, D.M., Guttuso, T.J., et al. (2004). Pilot study using gabapentin for tamoxifen-induced hot flashes in women with breast cancer. Breast Cancer Research and Treatment, 83, 87-89.

Pedhazur, E.J., & Schmelkin, L. (1991). Measurement, design, and analysis: An integrated approach. Mahwah, NJ: Lawrence Erlbaum.

Perez, D.G., Loprinzi, C.L., Barton, D.L., Pockaj, B.A., Sloan, J., Novotny, P.J., et al. (2004). Pilot evaluation of mirtazapine for the treatment of hot flashes. Journal of Supportive Oncology, 2, 50-56.

Ping, J., Ren-hai, M., & Zhong-xiang, W. (1998). Body acupuncture plus ear pressing in the treatment of menopausal syndrome. International Journal of Clinical Acupuncture, 9, 471-473.

Porzio, G., Trapasso, T., Martelli, S., Sallusti, E., Piccone, C., Mattei, A., et al. (2002). Acupuncture in the treatment of menopause-related symptoms in women taking tamoxifen. Tumori, 88, 128-130.

Quella, S.K., Loprinzi, C.L., Barton, D.L., Knost, J.A., Sloan, J.A., LaVasseur, B.I., et al. (2000). Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: A North Central Cancer Treatment Group Trial. Journal of Clinical Oncology, 18, 1068-1074.

Quella, S.K., Loprinzi, C.L., Sloan, J.A., Vaught, N.L., DeKrey, W.L., Fischer, T., et al. (1998). Long term use of megestrol acetate by cancer survivors for the treatment of hot flashes. Cancer, 82, 1784-1788.

Rossouw, J.E., Anderson, G.L., Prentice, R.L., LaCroix, A.Z., Kooperberg, C., Stefanick, M.L., et al. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial. JAMA, 288, 321-333.

Sanacora, G., Berman, R.M., Cappiello, A., Oren, D.A., Kugaya, A., Liu, N., et al. (2004). Addition of the alpha2-antagonist yohimbine to fluoxetine: Effects on rate of antidepressant response. Neuropsychopharmacology, 29, 1166-1171.

Sandberg, M., Wijma, K., Wyon, Y., Nedstrand, E., & Hammar, M. (2002). Effects of electro-acupuncture on psychological distress in postmenopausal women. Complementary Therapies in Medicine, 10, 161-169.

Sartor, O., & Eastham, J.A. (1999). Progressive prostate cancer associated with use of megestrol acetate administered for control of hot flashes. Southern Medical Journal, 92, 415-416.

Scambia, G., Mango, D., Signorile, P.G., Anselmi Angeli, R.A., Palena, C., Gallo, D., et al. (2000). Clinical effects of a standardized soy extract in postmenopausal women: A pilot study. Menopause, 7, 105-111.

Schober, C.E., & Ansani, N.T. (2003). Venlafaxine hydrochloride for the treatment of hot flashes. Annals of Pharmacotherapy, 37, 1703-1707.

Shumaker, S.A., Legault, C., Rapp, S.R., Thal, L., Wallace, R.B., Ockene, J.K., et al. (2003). Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women. The Women's Health Initiative Memory Study: A randomized controlled trial. JAMA, 289, 2651-2662.

Sloan, J.A., Loprinzi, C.L., Novotny, P.J., Barton, D.L., Lavasseur, B.I., & Windschitl, H. (2001). Methodologic lessons learned from hot flash studies. Journal of Clinical Oncology, 19, 4280-4290.

Soffa, V.M. (1996). Alternatives to hormone replacement for menopause. Alternative Therapies in Health and Medicine, 2(2), 34-39.

Stearns, V., Beebe, K.L., Iyengar, M., & Dube, E. (2003). Paroxetine controlled release in the treatment of menopausal hot flashes: A randomized controlled trial. JAMA, 289, 2827-2834.

Stearns, V., Isaacs, C., Rowland, J., Crawford, J., Ellis, M.J., Kramer, R., et al. (2000). A pilot trial assessing the efficacy of paroxetine hydrochloride (Paxil) in controlling hot flashes in breast cancer survivors. Annals of Oncology, 11, 17-22.

Stearns, V., Johnson, M.D., Rae, J.M., Morocho, A., Novielli, A., Bhargava, P., et al. (2003). Active tamoxifen metabolite plasma concentrations after coadministration of tamoxifen and the selective serotonin reuptake inhibitor paroxetine. Journal of the National Cancer Institute, 95, 1758-1764.

Stearns, V., & Loprinzi, C.L. (2003). New therapeutic approaches for hot flashes in women. Journal of Supportive Oncology, 1, 11-21.

St. Germain, A., Peterson, C.T., Robinson, J.G., & Alekel, D.L. (2001). Isoflavone-rich or isoflavone-poor soy protein does not reduce menopausal symptoms during 24 weeks of treatment. Menopause, 8, 17-26.

Stevenson, D.W., & Delprato, D.J. (1983). Multiple component self-control program for menopausal hot flashes. Journal of Behavior Therapy and Experimental Psychiatry, 14, 137-140.

Sun, J. (2003). Morning/evening menopausal formula relieves menopausal symptoms: A pilot study. Journal of Alternative and Complementary Medicine, 9, 403-409.

Suvanto-Luukkonen, E., Koivunen, R., Sundstrom, H., Bloigu, R., Karjalainen, E., Haiva-Mallinen, L., et al. (2005). Citalopram and fluoxetine in the treatment of postmenopausal symptoms: A prospective, randomized, 9-month, placebo-controlled, double-blind study. Menopause, 12, 18-26.

Swain, S., Santen, R., Burger, H., & Pritchard, K. (Eds.). (1999). Treatment of estrogen deficiency symptoms in women surviving breast cancer. Part 4: Urogenital atrophy, vasomotor instability, sleep disorders, and related symptoms. Proceedings of a conference held at the Boar's Head Inn, Charlottesville, Virginia. September 21-23, 1997. Oncology, 13, 551-563.

Thompson, E.A., & Reilly, D. (2003). The homeopathic approach to the treatment of symptoms of oestrogen withdrawal in breast cancer patients. A prospective observational study. Homeopathy, 92, 131-134.

Ueda, M. (2004). A 12-week structured education and exercise program improved climacteric symptoms in middle-aged women. Journal of Physiological Anthropology and Applied Human Science, 23, 143-148.

Upmalis, D.H., Lobo, R., Bradley, L., Warren, M., Cone, F.L., & Lamia, C.A. (2000). Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: A multicenter, double-blind, randomized, placebo-controlled study. Menopause, 7, 236-242.

U.S. Department of Health and Human Services. (2003). Estrogen and estrogen/progestin drug products to treat vasomotor symptoms and vulvar and vaginal atrophy symptoms—Recommendations for clinical evaluation: Draft guidance. Rockville, MD: Food and Drug Administration Center for Drug Evaluation and Research.

Van Patten, C.L., Olivotto, I.A., Chambers, G.K., Gelmon, K.A., Hislop, T.G., Templeton, E., et al. (2002). Effect of soy phytoestrogens on hot flashes in postmenopausal women with breast cancer: A randomized, controlled clinical trial. Journal of Clinical Oncology, 20, 1449-1455.

Weitzner, M.A., Moncello, J., Jacobsen, P.B., & Minton, S. (2002). A pilot trial of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer. Journal of Pain and Symptom Management, 23, 337-345.

Wijma, K., Melin, A., Nedstrand, E., & Hammar, M. (1997). Treatment of menopausal symptoms with applied relaxation: A pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 28, 251-261.

Williamson, J., White, A., Hart, A., & Ernst, E. (2002). Randomised controlled trial of reflexology for menopausal symptoms. British Journal of Obstetrics and Gynaecology, 109, 1050-1055.

Wyon, Y., Lindgren, R., Lundeberg, T., & Hammar, M. (1995). Effects of acupuncture on climacteric vasomotor symptoms, quality of life, and urinary excretion of neuropeptides among postmenopausal women. Menopause, 2, 3-12.