Which treatment is best for managing menopausal sleep problems? We tend to think of estrogen replacement therapy as being the best option for all menopausal symptoms; however, there are other options for managing menopausal symptoms, including serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors, and gabapentin. A recent study compares low-dose estradiol and low-dose venlafaxine for the treatment of sleep and vasomotor symptoms in menopausal women with hot flashes.

In this double-blind randomized trial, peri- and post-menopausal women received 17? estradiol 0.5 mg/day (n = 97), venlafaxine XR 75 mg/day (n = 96), or placebo (n = 146) for 8 weeks.

In this head-to-head comparison, low-dose estradiol and low-dose venlafaxine were similarly effective and produced a modest reduction insomnia symptoms and improvement in subjective sleep quality.

Ruta Nonacs, MD PhD

Ensrud KE, Guthrie KA, Hohensee C, Caan B, et al.  Effects of estradiol and venlafaxine on insomnia symptoms and sleep quality in women with hot flashes.  Sleep. 2015 Jan 1;38(1):97-108.