Many women find the hot flashes and night sweats of menopause uncomfortable, but for some women these symptoms are unbearable. The standard treatment is estrogen replacement therapy. While estrogen is effective, the evidence from the Women’s Health Initiative that Premarin and Provera increased the risk for blood clots, heart attacks, strokes and breast cancer greatly reduced the popularity of this treatment.
The National Institutes of Health funded a study called MsFLASH of treatments for the hot flashes and night sweats of menopause. Low-dose estradiol (0.5 mg/day), low-dose venlafaxine (75 mg/day, a starting dose for this antidepressant) and placebo were compared in a randomized controlled trial of more than 300 women. The women kept diaries of their symptoms during the eight weeks of the trial.
At the start of the study, women experienced an average of about 8 hot flashes daily. Both estradiol and venlafaxine reduced the number by about half, which was more than the reduction among women taking placebo. About 70 percent of the women taking estradiol were pleased with their results, compared to roughly half of those on venlafaxine and not quite 40 percent of those on placebo. Side effects included insomnia for those on estradiol and fatigue among those taking venlafaxine. Some women also developed elevated blood pressure.
The investigators concluded that differences in response between the two treatments were minimal, although both were better than placebo. This research offers women a few options for managing menopausal symptoms that they have not had until now. Another antidepressant, paroxetine, originally sold as Paxil, is now available under the brand name Brisdelle to treat moderate to severe hot flashes.
[JAMA Internal Medicine, online May 26, 2014]
Our Guide to Menopause discusses some alternative approaches to quelling hot flashes.
