What are the medication options for hot flashes in perimenopause (perimenopausal syndrome)?

From the Guidelines

For hot flashes during perimenopause, gabapentin is a recommended non-hormonal medication option, with a dose of 900 mg/day, as it has been shown to be effective in reducing hot flashes by 51% compared to 26% with placebo 1.

Medication Options

• Gabapentin: 900 mg/day, with a rapid onset of action and few side effects, making it a suitable option for women with perimenopause symptoms 1
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenalin reuptake inhibitors (SNRIs): such as paroxetine (7.5mg daily) or venlafaxine (37.5-75mg daily), which can reduce hot flashes by 50-60% 1
• Clonidine: 0.1mg daily, an antihypertensive medication that has been used to reduce hot flashes 1

Lifestyle Changes

• Dress in layers to manage body temperature
• Avoid triggers like spicy foods, caffeine, and alcohol
• Maintain a healthy weight
• Practice stress reduction techniques, such as rhythmic breathing and exercise

Important Considerations

• Discuss medical history with a healthcare provider before starting any medication, as some options may not be suitable for women with certain conditions like breast cancer or blood clotting disorders 1
• The optimal duration of treatment is unknown, and medications should be stopped gradually to prevent discontinuation symptoms 1

From the FDA Drug Label

CLINICAL STUDIES Effects on vasomotor symptoms In the first year of the Health and Osteoporosis, Progestin and Estrogen (HOPE) Study, a total of 2,805 postmenopausal women (average age 53.3 ± 4. 9 years) were randomly assigned to one of eight treatment groups, receiving either placebo or conjugated estrogens, with or without medroxyprogesterone acetate Efficacy for vasomotor symptoms was assessed during the first 12 weeks of treatment in a subset of symptomatic women (n = 241) who had at least seven moderate to severe hot flushes daily, or at least 50 moderate to severe hot flushes during the week before randomization. PREMARIN (0.3 mg, 0.45 mg, and 0. 625 mg tablets) was shown to be statistically better than placebo at weeks 4 and 12 for relief of both the frequency and severity of moderate to severe vasomotor symptoms. What is PREMARIN used for? PREMARIN is used after menopause to: Reduce moderate to severe hot flashes

Medication options for hot flashes in perimenopause include:

• Conjugated estrogens (PO) 2 Key points:
• Conjugated estrogens have been shown to be effective in reducing the frequency and severity of moderate to severe hot flashes in postmenopausal women.
• The medication is available in different dosages, including 0.3 mg, 0.45 mg, and 0.625 mg tablets.
• It is essential to consult a healthcare provider to determine the best course of treatment for hot flashes in perimenopause.

From the Research

Medication Options for Hot Flashes in Perimenopause

• Hormonal therapy with estrogen is considered the first-line therapy for bothersome vasomotor symptoms, including hot flashes, and can reduce their frequency by approximately 75% 3.
• Systemic estrogen alone or combined with a progestogen can be used, with oral and transdermal estrogen having similar efficacy 3.
• Nonhormonal options, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can also be effective in reducing hot flashes, with a reduction in frequency of approximately 40% to 65% 3, 4.
• Specific medications that have been shown to be effective in reducing hot flashes include:
  • SSRIs: escitalopram, paroxetine, and fluoxetine 4.
  • SNRIs: venlafaxine and desvenlafaxine 4.
  • Other medications: gabapentin, citalopram, and venlafaxine 3, 5.

Considerations for Hormonal Therapy

• Hormonal therapy with estrogen is not indicated for the prevention of cardiovascular disease 3.
• Combined estrogen/progestogen therapy may increase the risk of breast cancer when used for more than three to five years 5.
• Low-dose estrogen therapy may be an option for women who cannot tolerate standard doses, but its efficacy and safety are still being studied 6.

Alternative Therapies

• Lifestyle modifications, such as stress reduction and relaxation therapy, may also be helpful in managing hot flashes 7.
• Some studies suggest that soy products and clinical hypnosis may have a modest effect on reducing hot flashes, but more research is needed to confirm these findings 5, 7.