From the Guidelines
The most effective non-hormonal medications for menopausal hot flashes are venlafaxine, paroxetine, and gabapentin, with venlafaxine being a preferred option due to its efficacy and safety profile, as supported by the most recent and highest quality study 1. When considering treatment options for menopausal hot flashes, it is essential to prioritize individual symptoms, medical history, and preferences.
- Non-hormonal alternatives, such as venlafaxine, paroxetine, and gabapentin, can effectively reduce the frequency and severity of hot flashes.
- A typical regimen for venlafaxine might include a starting dose of 37.5 mg, with incremental increases as needed and tolerated, as suggested by the study 1.
- Gabapentin has also been shown to be effective in reducing hot flashes, with a typical dose of 300 mg three times daily, as reported in the study 1.
- The choice of medication should be based on individual symptoms, medical history, and preferences, as each option has its own set of benefits and potential side effects.
- It is crucial to consider the potential risks and benefits of each treatment option, particularly for women with a history of breast cancer or blood clots, as highlighted in the study 1.
- Lifestyle modifications, such as avoiding spicy foods, caffeine, and alcohol, and environmental modifications, like cool rooms and dressing in layers, can also be helpful in reducing the intensity and severity of menopausal symptoms, as suggested by the study 1.
From the Research
Medications for Hot Flashes
The primary medications used to treat hot flashes associated with menopause include:
- Hormone replacement therapy (HRT) 2, 3, 4, 5, 6
- Selective serotonin and norepinephrine reuptake inhibitors (SSNRIs) 4, 6
- Centrally acting nonhormonal therapies, such as:
- Selective estrogen receptor modulators (SERMs), such as bazedoxifene 3, 6
Hormone Replacement Therapy (HRT)
HRT is considered the most effective treatment for menopausal symptoms, including hot flashes, and is the only treatment approved by the US Food and Drug Administration (FDA) for this indication 2, 3, 6. The FDA recommends using the lowest effective dose of hormones 2. HRT can be administered in various forms, including injections and transdermal formulations 3. For women with an intact uterus, estrogen must be combined with progestin or a SERM to minimize malignancy risk 3.
Non-Hormonal Therapies
Non-hormonal therapies, such as SSNRIs and centrally acting agents, can be effective in relieving hot flashes 4, 6. These therapies may be considered for women who are not candidates for HRT or prefer alternative treatments. Additionally, lifestyle modifications, such as paced respiration, yoga, and exercise, may also be beneficial in managing hot flashes 6.