The FDA recently approved a 7.5-mg formulation of the selective serotonin reuptake inhibitor (SSRI) paroxetine mesylate for the treatment of hot flashes. It will be marketed under the name of Brisdelle.
We previously reported on studies suggesting estrogen may be helpful for the treatment of depression in peri- and post-menopausal women, either alone or in combination with an antidepressant. In addition, other studies have suggested that older, postmenopausal women may respond more poorly to antidepressants than premenopausal women. Two recent studies attempt to better understand the impact of reproductive hormones on clinical presentation and treatment response of depression in women.
Studies assessing the effectiveness of complementary and alternative medicines (CAM) for the treatment of menopause-related hot flashes have yielded conflicting results. Most studies have demonstrated that treatments such as soy and black cohosh are not likely to be effective in most women; however, a new study suggests that women who take higher doses (100 to 200 mg)of isoflavones and more frequent dosing (2-3 times per day) may experience a greater reduction in the frequency of hot flashes.
For the treatment of menopausal vasomotor symptoms (VMS), such as hot flashes and night sweats, selective serotonin reuptake inhibitors (SSRIs) are effective and well-tolerated. Positive effects are observed within 4 weeks of the initiation of treatment. However, we do not know how long treatment with an SSRI must be continued in order to maintain control of VMS. Nor do we know if VMS will recur after discontinuation of SSRI or if recurrent VMS may be less frequent or less bothersome after receiving SSRI treatment. A recent report from Dr. Hadine Joffe and colleagues at the Center for Women’s Mental Health assessed the recurrence of vasomotor symptoms in women treated with SSRIs.
In a large study from Australia, researchers found that menopausal women who ate diets high in fruit, certain vegetables, pasta and red wine were 20% less likely to have hot flashes and night sweats.
A substantial proportion of women transitioning into menopause experience a new onset or recurrence of depressive symptoms. A new study from the Center for Women’s Mental Health indicates that duloxetine (Cymbalta) is effective for the treatment of depression and may also have a beneficial effect on vasomotor symptoms (hot flashes and night sweats).
Aromatase inhibitors (AIs) are the preferred hormonal therapy for postmenopausal women with estrogen sensitive breast cancer. While the selective estrogen receptor modulators (SERMs), such as tamoxifen and raloxifene, are used in premenopausal women with estrogen sensitive breast cancer, the aromatase inhibitors (e.g., anastrozole, letrozole, and exemestane) have been shown to be more effective and safer than the SERMs in postmenopausal women.
Peri- and post-menopausal women have various options for the management of hot flashes, including hormone replacement therapy, SSRIs, and gabapentin. It looks as if hypnosis may also be helpful. In a recent study, researchers randomly assigned postmenopausal women to hypnotherapy or "structured attention," which was used as a control intervention.
Several studies have shown that gabapentin (Neurontin) at 600-2400 mg/day in divided doses is effective for treating hot flashes in menopausal women. Research presented at the annual meeting of the North American Menopause Society (NAMS) indicates that an investigational extended release (ER) formulation of gabapentin (Serada, Depomed) is effective for the treatment of hot flashes and sleep disturbance.
For decades, estrogen has been used to treat menopausal symptoms, including night sweats and hot flashes. However, after studies reported that estrogen increases the risk of cardiovascular disease and breast cancer, many patients and clinicians have looked into alternative treatments for hot flashes, including selective serotonin reuptake inhibitors (SSRIs).
