Design and methods of a multi-site, multi-behavioral treatment trial for menopausal symptoms: The MsFLASH experience

Barbara Sternfeld, Andrea LaCroix, Bette J. Caan, Andrea L. Dunn, Katherine M. Newton, Susan D. Reed, Katherine A. Guthrie, Cathryn Booth-LaForce, Karen J. Sherman, Lee Cohen, Marlene P. Freeman, Janet S. Carpenter, Julie R. Hunt, Melanie Roberts, Kristine E. Ensrud

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Background: Behavioral strategies are recommended for menopausal symptoms, but little evidence exists regarding efficacy. Purpose: Describe design and methodology of a randomized controlled 3 by 2 factorial trial of yoga, exercise and omega-3 fatty acids. Methods: Women from three geographic areas with a weekly average of ≥ 14 hot flashes/night sweats, who met exclusion/inclusion criteria, were randomized to 12. weeks of: 1) yoga classes and daily home practice; 2) supervised, facility-based aerobic exercise training; or 3) usual activity. Women in each arm were further randomized to either omega-3 supplement or placebo. Standardized training, on-going monitoring, and site visits were adopted to ensure consistency across sites and fidelity to the intervention. Participant adherence to the intervention protocol was monitored continuously, and retention was actively encouraged by staff. Information on adverse events was systematically collected. Results: Of 7377 women who responded to mass mailings, 355 (4.8%) were randomized; mean age was 54.7 (sd=3.7), 26.2% were African American, 81.7% were post-menopausal, and mean baseline frequency of daily hot flashes/night sweats was 7.6 (sd=3.8). Adherence of ≥ 80% was 59% for yoga, 77% for exercise training, and 80% for study pills. Final week 12 data were collected from 95.2%. Conclusions: Conducting a multi-site, multi-behavioral randomized trial for menopausal symptoms is challenging but feasible. Benefits included cost-effective study design, centralized recruitment, and methodologic standardization.

Original languageEnglish (US)
Pages (from-to)25-34
Number of pages10
JournalContemporary Clinical Trials
Issue number1
StatePublished - May 2013

Bibliographical note

Funding Information:
This study was supported by a cooperative agreement issued by the National Institute of Aging (NIA) , in collaboration with the Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD), the National Center for Complementary and Alternative Medicine (NCCAM) and the Office of Research and Women's Health (ORWH), and grants U01 AG032656 , U01AG032659 , U01AG032669 , U01AG032682 , U01AG032699 , U01AG032700 from the NIA. At the Indiana University site, the project was funded in part with support from the Indiana Clinical and Translational Sciences Institute , funded in part by grant UL1 RR025761 from the National Institutes of Health, National Center for Research Resources, Clinical and Translational Sciences Award .

Funding Information:
Drs. Newton and Reed reported research support from Otsuka Pharmaceutical Co., Ltd.


  • Exercise
  • Factorial design
  • Omega-3 fatty acids
  • Randomized controlled trial
  • Vasomotor symptoms
  • Yoga


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