Clinical Question

Should exercise be prescribed to treat vasomotor symptoms of menopause?

Evidence-Based Answer

Although menopausal women who exercise are less likely to report vasomotor symptoms than those who do not, there is insufficient evidence that counseling women to exercise is more effective than no treatment or hormone therapy for vasomotor symptoms of menopause. (Strength of Recommendation: C, based on consensus, disease-oriented evidence, usual practice, expert opinion, or case series.)

Practice Pointers

Menopause is marked by a decline in estrogen levels, which can result in insomnia, fatigue, depression, and vasomotor symptoms, also known as hot flashes. Hormone therapy is more effective than placebo in alleviating hot flashes.¹ Because women who exercise regularly report fewer symptoms of menopause than those who do not exercise regularly,² increasing physical activity may reduce vasomotor symptoms.

To determine if an exercise prescription can improve vasomotor symptoms, the authors of this Cochrane review searched the literature for randomized controlled trials comparing exercise with no treatment, yoga, or hormone therapy. Six studies of 276 women from five countries were identified and combined in three meta-analyses.

Exercise prescriptions were broadly defined, with most studies including two to three weekly sessions of low- to moderate-intensity aerobic activity, such as walking, biking, or aerobics. Patients were encouraged to continue regular exercise for two to 18 months. Exercise prescriptions were comparable with no treatment or nonexercise controls (e.g., dietary prescriptions), and also were no better than yoga. There was no statistically significant overall difference between exercise and hormone therapy, but all individual studies favored hormone therapy. The small number of participants and the heterogeneity of the studies led the authors to conclude that the data are insufficient to determine whether an exercise prescription can be used to treat hot flashes.

Although exercise has well-established cardiovascular benefits and relatively little risk, it remains uncertain if it effectively relieves the vasomotor symptoms of menopause. The Society of Obstetricians and Gynaecologists of Canada notes that exercise may be recommended for mild symptoms based on conflicting evidence.³ The North American Menopause Society does not include exercise in its recommendations for management of vasomotor symptoms.⁴