Effect of menopausal symptom treatment options on palpitations: a systematic review

Abstract

This systematic review provides an overview of the effects of menopausal symptom treatment options on palpitations, defined as feelings of missed or exaggerated heart beats, reported by perimenopausal and postmenopausal women. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searches were conducted in PubMed, CINAHL and PsycINFO to identify articles meeting pre-specified inclusion criteria. Of 670 unique articles identified, 37 were included in the review. Treatments included drug therapies and non-drug therapies. Palpitations were studied as an outcome in 89% of articles and as an adverse effect in 11%. Articles provided mostly level II/III evidence due to their design and/or small sample sizes. Based on available evidence, no therapies can be fully recommended for clinical practice. Only some hormonal agents (e.g. estradiol) can be recommended with caution based on some positive evidence for reducing palpitation prevalence or severity. However, other drug therapies (e.g. moxonidine, atenolol), dietary supplementary treatments (e.g. isoflavones, Rheum rhaponticum, sage), cognitive-behavioral intervention and auricular acupressure cannot be recommended given the existing evidence. Additional well-designed randomized controlled treatment trials focusing on palpitations during the menopause transition as an inclusion criteria and outcome are needed to advance the field.

绝经症状的治疗选择对心悸的影响：系统综述 摘要

本系统综述总结了更年期症状的治疗方案对心悸的影响, 由围绝经期和绝经后女性自报告的心悸定义为心跳停顿或加速。在系统综述及荟萃分析优先报告条目（PRISMA）指南的引导下, 在PubMed、CINAHL和PsycINFO数据库中检索符合预设纳入标准的文献。在检索到的670篇文献中, 最终筛选出37篇。治疗方法包括药物治疗和非药物治疗。89%的文章将心悸视为治疗结果, 11%的文章将心悸视为副作用。由于实验设计和/或样本量偏小, 文献证据大多属于II/III级。基于现有证据, 没有任何疗法可以完全推荐给临床实践。一些积极证据显示, 只有某些激素类药物（如雌二醇）可谨慎用于减低心悸患病率或严重程度。其他药物疗法（如莫索尼定、阿替洛尔）、膳食补充疗法（如异黄酮、大黄、鼠尾草）、认知-行为干预、按摩耳穴等, 现有证据质量尚不足以做出推荐。治疗绝经过渡期心悸的研究, 尚需进一步优化其纳入标准和结局的设计, 以提高随机对照试验的质量。

Keywords:

• Menopausal therapy
• palpitations
• menopause
• postmenopause
• perimenopause
• menopausal symptoms
• systematic review

Acknowledgments

The authors acknowledge Ms Caitlin Pike for her assistance with the electronic searches. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Potential conflict of interest

Dr Carpenter reports personal fees from RoundGlass Inc., personal fees from Astellas Pharma Inc., personal fees from Kappa Santé, personal fees from Sojournix, personal fees from Mapi/ICON and other from QUE oncology. Mr Elomba, Ms Alwine, Ms Yue, Dr Sheng, Dr Chen and Dr Tisdale have nothing to disclose.

Additional information

Funding

This publication was made possible with support of Indiana University Ethel Clarke Fellowship; Collaboration in Translational Research Grant from Indiana Clinical and Translational Sciences Institute funded in part by National Institutes of Health [Grant Number UL1TR002529]; National Center for Advancing Translational Sciences [Clinical and Translational Sciences Award]. Dr Sheng is supported as a postdoctoral fellow [5T32CA117865] (V. Champion, PI).