Condition

Menopause

Natural decline in reproductive hormones

1B
People Affected
292
Active Trials
47M
New Cases/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Estrogen-Progestogen Therapy (EPT)
90% Effectiveness• 95% Confidence• 60% Safety• 1 trials• 500K participants
HIGH EvidenceGood ValueDose: Oral Estradiol 0.5-1mg daily with progestogen (e.g., Micronized Progesterone 100-200mg daily or cyclically)
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Comparative Safety Scale(Higher is safer)

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Meth💀
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60
DangerousModerateSafe

Time to Effect

1-4 weeks

Duration

2-5 years, reassess

Response Rate

85%

Remission Rate

65%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

1000

Common Side Effects:

Breast tenderness: 25%
Nausea: 8%
Headache: 12%
Vaginal bleeding/spotting: 15%
Bloating: 10%
Increased risk of VTE: 0.03%
Increased risk of breast cancer (long-term use): 0.05%

Annual Cost of Care

Drug Cost

$500

Monitoring

$300

Side Effects

$75

Total Annual

$875

Cost-Effectiveness

GOOD

QALYs Gained

0.5

ICER

$45,000/QALY

Cost per Remission

$1,346.15

Cost per Responder

$1,029.41

Treatment Outcomes
Primary Outcomes
Moderate-to-Severe Hot Flash Frequency10 hot flashes/day
-85% (-8.5 hot flashes/day)
Vaginal Dryness Severity (0-3 scale)2.5 points on a 0-3 scale (higher is worse)
-60% (-1.5 points)
Menopause Rating Scale (MRS) Total Score28/44 points (higher is worse)
-50% (-14 points)
Secondary Benefits
Lumbar Spine Bone Mineral Density (BMD)0.950 g/cm^2 (typical post-menopause)
+2% (+0.019 g/cm^2)
Sleep Disturbance Severity (Insomnia Severity Index, 0-28)18/28 points (moderate insomnia)
-40% (-7.2 points)
Depressive Symptoms (PHQ-9 score, 0-27)12/27 points (moderate depression)
-30% (-3.6 points)
Common Side Effects
Breast tenderness
+25%
Nausea
+8%
Headache
+12%

Clinical Trial Phases:

Phase 4
2
Fezolinetant
88% Effectiveness• 85% Confidence• 65% Safety• 17 trials• 7K participants
HIGH EvidencePoor ValueDose: 45mg orally once daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
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65
DangerousModerateSafe

Time to Effect

1-4 weeks

Duration

Long-term, as needed

Response Rate

65%

Remission Rate

35%

Number Needed to Treat (NNT)

5

Number Needed to Harm (NNH)

1000

Common Side Effects:

Abdominal pain: 7%
Diarrhea: 6%
Insomnia: 4%
Back pain: 4%
Liver enzyme elevations: 3%

Annual Cost of Care

Drug Cost

$7,000

Monitoring

$200

Side Effects

$100

Total Annual

$7,300

Cost-Effectiveness

POOR

QALYs Gained

0.3

ICER

$250,000/QALY

Cost per Remission

$20,857.14

Cost per Responder

$11,230.77

Treatment Outcomes
Primary Outcomes
Frequency of Moderate to Severe Vasomotor Symptoms (VMS)10.0 VMS episodes per day
-60% (-6.0 VMS episodes per day)
Severity of Moderate to Severe Vasomotor Symptoms (VMS)2.5 (on a 0-3 point scale, 0=none, 3=severe)
-35% (-0.9 points)
Wake-up Frequency due to Vasomotor Symptoms2.0 awakenings per night
-45% (-0.9 awakenings per night)
Secondary Benefits
Menopause-Specific Quality of Life (MSQoL) Vasomotor Domain Score3.5 (on a 1-5 scale, 1=no bother, 5=extreme bother)
-20% (-0.7 points)
Sleep Interference due to Vasomotor Symptoms2.8 (on a 0-10 scale, 0=no interference, 10=complete interference)
-30% (-0.8 points)
Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Score30 (on a 0-52 scale, higher score means less fatigue)
+10% (+3.0 points)
Common Side Effects
Abdominal pain
+7%
Diarrhea
+6%
Insomnia
+4%

Clinical Trial Phases:

Phase 4
3
Paroxetine (low-dose)
70% Effectiveness• 80% Confidence• 60% Safety• 4 trials• 7.5K participants
HIGH EvidenceExcellent ValueDose: 7.5mg orally once daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
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Tylenol💊
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Water💧
60
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Long-term, as needed

Response Rate

55%

Remission Rate

25%

Number Needed to Treat (NNT)

7

Number Needed to Harm (NNH)

1000

Common Side Effects:

Nausea: 15%
Insomnia/Somnolence: 12%
Fatigue: 8%
Headache: 10%
Dry mouth: 7%
Sexual dysfunction: 7%

Annual Cost of Care

Drug Cost

$200

Monitoring

$100

Side Effects

$50

Total Annual

$350

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.15

ICER

$30,000/QALY

Cost per Remission

$1,400

Cost per Responder

$636.36

Treatment Outcomes
Primary Outcomes
Frequency of Moderate-to-Severe Vasomotor Symptoms7.4 hot flashes/day
-60% (-4.4 hot flashes/day)
Daily Hot Flash Bother Score (0-3 scale)2.5 points (moderate bother)
-32% (-0.8 points)
Menopause Rating Scale (MRS) Total Score18.0 points (moderate symptoms; scale 0-44)
-25% (-4.5 points)
Secondary Benefits
Pittsburgh Sleep Quality Index (PSQI) Score10.0 points (poor sleep quality; scale 0-21)
-28% (-2.8 points)
Menopause-Specific Quality of Life (MENQOL) Overall Score3.5 points (overall distress; scale 1-8, higher worse)
-18% (-0.6 points)
Patient Health Questionnaire (PHQ-9) Score9.0 points (mild depression; scale 0-27)
-15% (-1.4 points)
Common Side Effects
Nausea
+15%
Insomnia/Somnolence
+12%
Fatigue
+8%

Clinical Trial Phases:

Phase 4
4
Gabapentin
65% Effectiveness• 80% Confidence• 65% Safety• 6 trials• 4K participants
MODERATE EvidenceExcellent ValueDose: 300-900mg orally daily, often dosed at bedtime
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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Chemo☢️
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Morphine💊
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65
DangerousModerateSafe

Time to Effect

1-4 weeks

Duration

Long-term, as needed

Response Rate

57.5%

Remission Rate

25%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

2000

Common Side Effects:

Dizziness: 20%
Somnolence/Sedation: 15%
Headache: 7%
Peripheral edema: 7%
Weight gain: 7%

Annual Cost of Care

Drug Cost

$120

Monitoring

$100

Side Effects

$50

Total Annual

$270

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.15

ICER

$20,000/QALY

Cost per Remission

$1,080

Cost per Responder

$469.57

Treatment Outcomes
Primary Outcomes
Daily Hot Flash Frequency8 hot flashes/day
-55% (-4.4 hot flashes/day)
Daily Hot Flash Severity Score (0-3 scale)2.0 points/day
-30% (-0.6 points/day)
Nighttime Hot Flash Frequency3 hot flashes/night
-60% (-1.8 hot flashes/night)
Secondary Benefits
Pittsburgh Sleep Quality Index (PSQI) Score11/21
-23% (-2.5 points)
Menopause Rating Scale (MRS) Total Score25/44
-20% (-5 points)
Generalized Anxiety Disorder 7-item (GAD-7) Score12/21
-17% (-2 points)
Common Side Effects
Dizziness
+20%
Somnolence/Sedation
+15%
Headache
+7%

Clinical Trial Phases:

Phase 4
5
Cognitive Behavioral Therapy (CBT) for Menopausal Symptoms
65% Effectiveness• 85% Confidence• 95% Safety• 12 trials• 3.5K participants
HIGH EvidenceGood ValueDose: 8-12 weekly sessions, 60 minutes each
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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95
DangerousModerateSafe

Time to Effect

4-12 weeks

Duration

8-12 weeks initial, skills for lifetime

Response Rate

67.5%

Remission Rate

40%

Number Needed to Treat (NNT)

4

Annual Cost of Care

Drug Cost

$0

Monitoring

$50

Side Effects

$0

Total Annual

$800

Cost-Effectiveness

GOOD

QALYs Gained

0.2

ICER

$40,000/QALY

Cost per Remission

$2,000

Cost per Responder

$1,185.19

Treatment Outcomes
Primary Outcomes
Hot Flash Severity (Daily Bother Score)5.5/10 (0=no bother, 10=maximum bother)
-30% (-1.7 points)
Insomnia Severity Index (ISI) Score18/28 (moderate clinical insomnia)
-25% (-4.5 points)
HADS-Anxiety Score12/21 (moderate anxiety)
-28% (-3.4 points)
Menopause Rating Scale (MRS) - Psychological Subscale8/16 (moderate psychological symptoms)
-22% (-1.8 points)
Secondary Benefits
Menopause-Specific Quality of Life (MenQOL) - Overall Score4.0/6.0 (higher score = worse QoL)
-15% (-0.6 points)
HADS-Depression Score10/21 (mild-moderate depression)
-20% (-2.0 points)
Female Sexual Function Index (FSFI) Total Score20/36 (suggests sexual dysfunction)
+12% (+2.4 points)
6
Oxybutynin (low-dose extended release)
60% Effectiveness• 75% Confidence• 55% Safety• 8 trials• 1.5K participants
MODERATE EvidenceExcellent ValueDose: 2.5-5mg extended-release orally once daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
55
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Long-term, as needed

Response Rate

50%

Remission Rate

20%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

500

Common Side Effects:

Dry mouth: 25%
Constipation: 15%
Dizziness: 7%
Blurred vision: 7%
Somnolence: 7%

Annual Cost of Care

Drug Cost

$180

Monitoring

$100

Side Effects

$50

Total Annual

$330

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.1

ICER

$20,000/QALY

Cost per Remission

$1,650

Cost per Responder

$660

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+60%
Response Rate
+50%
Remission Rate
+20%
Common Side Effects
Dry mouth
+25%
Constipation
+15%
Dizziness
+7%

Clinical Trial Phases:

Phase 4