Women’s Treatment Preferences for Moderate to Severe Vasomotor Symptoms Associated with Menopause: Insights from the WARMER Study

Vasomotor symptoms (VMS) affect up to 80% of women over the course of their menopause and can impair functioning as well as quality of life. Hormone therapy (HT) is the standard of care, but concerns about long-term safety may be a barrier to uptake. Emerging non-hormonal therapies could be an alternative for some women. This study elicited benefit–risk trade-offs that post-menopausal women were willing to make to treat their VMS, with a focus on long-term safety. A discrete choice experiment (DCE) was developed and tested using iterative interviews (N = 45) with women from Australia, Canada, Denmark, France, Germany, Spain, Sweden, and the UK as well as input from a steering committee. In total, 1465 women were included in the final analysis. Women made a series of choices between two hypothetical treatments and an opt out differing in moderate to severe VMS frequency, other menopause symptom improvement, time to symptom improvement, and 5-year risks of breast cancer, blood clots and osteoporosis. Data were analysed using a finite mixture of random parameter logit models to account for complex levels of preference heterogeneity. Relative attribute importance (RAI) and maximum acceptable risk were derived from the model estimates as the main behavioural outputs. In total, 1465 women completed the final DCE survey. The most influential attribute was the 5-year blood clot risk (RAI 26.4–28.4%). Relief of other menopause symptoms and other VMS symptoms were also important attributes. Assuming 5–9 years’ use of HT with an associated relative risk of 1.97, breast cancer risk was the fourth most important attribute. Women were willing to accept an extra 0.5% blood clot risk or an extra 0.25% breast cancer risk for every 10% reduction in VMS frequency. Preferences were heterogeneous, with a model mixing three continuous parameters offering the best compromise between parsimony and data fit. Women valued safe efficacious VMS treatment, with high importance on avoiding long-term risks. Reducing VMS frequency mattered over and above wider menopause symptoms; however, treatment priorities were highly individual. Almost 8 out of 10 women experience hot flushes/and or night sweats during their menopausal transition. Moderate or severe hot flushes/night sweats can be distressing and may have negative impacts on daily living. Hormone therapy is traditionally used to treat hot flushes/night sweats, but some women are hesitant, after reports about long-term risks of conditions such as breast cancer or blood clots. Non-hormonal therapies may be an alternative for women, but the optimal choice is specific to individuals. In this study, we explored the treatment priorities of women with 14 or more moderate to severe hot flushes/night sweats per week to better understand their perspectives. Women were concerned about long-term safety but considered reducing hot flushes/and or night sweats as important. Reducing other symptoms of menopause was also very important to women. When being presented with an alternative treatment option or the choice to not take any treatment for VMS, women preferred a treatment in about half of the choice situations, which showed that they carefully weighed their desire to be treated with their concerns about risks. Views on what was most important when selecting a treatment differed a lot between women.