What is the efficacy of Venlafaxine (Effexor) for treating vasomotor symptoms in postmenopausal women?

From the Guidelines

Venlafaxine is a highly effective treatment option for vasomotor symptoms in postmenopausal women, with a recommended starting dose of 37.5 mg daily of extended-release venlafaxine, which can be increased to 75 mg daily if needed after one week, as supported by the most recent and highest quality study 1.

Key Points

• Venlafaxine works by increasing serotonin and norepinephrine levels in the brain, which helps regulate the body's temperature control mechanisms that become dysregulated during menopause.
• Treatment duration typically ranges from 8-12 weeks, though some women may benefit from longer treatment.
• Side effects may include nausea, dry mouth, constipation, decreased appetite, and sleep disturbances, particularly when initiating therapy.
• This medication should be tapered gradually when discontinuing to avoid withdrawal symptoms.

Benefits and Considerations

• For women who cannot or choose not to use hormone therapy, venlafaxine represents one of the most effective non-hormonal options for managing vasomotor symptoms, with studies showing a 60-75% reduction in hot flash frequency and severity 1.
• Women with a history of breast cancer, blood clots, or cardiovascular disease who may not be candidates for hormone therapy may particularly benefit from venlafaxine treatment.
• The American Society of Clinical Oncology recommends venlafaxine as an alternative to hormone therapy for women with vasomotor symptoms 1.

Comparison with Other Options

• Other non-hormonal options, such as gabapentin and clonidine, may also be effective in managing vasomotor symptoms, but venlafaxine has been shown to be one of the most effective options 1.
• Lifestyle modifications, such as rhythmic breathing, exercise, and avoiding spicy foods, caffeine, and alcohol, may also be helpful in reducing vasomotor symptoms, but are often not sufficient on their own to provide adequate relief.

From the Research

Venlafaxine for Vasomotor Symptoms in Postmenopausal Women

• Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that has been studied for its efficacy in managing vasomotor symptoms (hot flashes and night sweats) in postmenopausal women 2, 3, 4, 5.
• The evidence suggests that venlafaxine can reduce the frequency and severity of hot flashes in postmenopausal women, with reductions ranging from 37 to 61 percent 3.
• Venlafaxine is considered a viable option for reducing the frequency and severity of hot flashes, especially for women who cannot or choose not to use hormone therapy due to potential risks such as breast cancer and thromboembolic disorders 3.
• The most common adverse effects associated with venlafaxine are headache, dry mouth, nausea, insomnia, somnolence, and dizziness 3, 5.
• SNRIs, including venlafaxine, have been associated with increased blood pressure in some patients and should be used with caution in women with hypertension 5.

Comparison with Other Treatments

• Venlafaxine has been compared to other non-hormonal treatments for vasomotor symptoms, including selective serotonin reuptake inhibitors (SSRIs), gabapentin, and black cohosh 2, 4.
• The evidence suggests that venlafaxine is more effective than some of these alternatives, but may have a similar efficacy to others, such as desvenlafaxine 3.
• The choice of treatment should be patient-specific and take into account individual preferences and medical history 2, 5.

Clinical Considerations

• Venlafaxine should be used with caution in women with a history of breast cancer and taking tamoxifen, as SSRIs have been shown to interfere with tamoxifen metabolism 5.
• SNRIs, including venlafaxine, are considered a safer option for women with a history of breast cancer 5.
• Treatment with venlafaxine should start with the lowest dose available and be titrated as needed to minimize adverse effects 5.