From the Guidelines
Gabapentin is the most effective non-hormonal treatment for postmenopausal hot flashes, with a dose of 900 mg/day reducing hot flash severity by 46% at 8 weeks, as shown in a study of 420 breast cancer survivors 1. The treatment of postmenopausal hot flashes should prioritize non-hormonal options, given the potential risks associated with hormone replacement therapy.
- Non-hormonal alternatives include:
- Gabapentin (300-900mg daily)
- Certain antidepressants, such as paroxetine (7.5-20mg daily) and venlafaxine (37.5-150mg daily)
- Clonidine (0.1-0.2mg daily)
- Lifestyle modifications can also help alleviate symptoms, including:
- Dressing in layers
- Avoiding triggers like spicy foods and alcohol
- Maintaining a cool bedroom
- Practicing relaxation techniques
- The use of gabapentin is supported by multiple studies, including a randomized clinical trial that demonstrated its efficacy in reducing hot flash severity and frequency in breast cancer survivors 1.
- While antidepressants like paroxetine and venlafaxine can also be effective, their use may be limited by potential interactions with other medications, such as tamoxifen, and side effects like dry mouth, decreased appetite, and fatigue 1.
- Lifestyle modifications, such as weight loss and smoking cessation, may also help alleviate hot flash symptoms, as suggested by studies in the general population and breast cancer survivors 1.
From the Research
Treatment Options for Postmenopausal Hot Flashes
- The most effective treatment for hot flashes is short-term estrogen, but due to safety concerns, many women are reluctant to use this treatment 2.
- Non-hormonal pharmacologic treatments, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), have been shown to reduce hot flashes by 50-60% 2, 3.
- Specific SSRIs, such as paroxetine, citalopram, and escitalopram, and SNRIs, such as venlafaxine, have been found to be effective in reducing hot flashes 4, 3.
- Gabapentin is another drug that appears promising as therapy for women unable or unwilling to use estrogen 5.
- Hormone therapy remains the most effective treatment for menopausal symptoms, but the US Food and Drug Administration (FDA) recommends using the lowest effective dose of hormones 6.
Considerations for Treatment
- Women with a history of breast cancer and taking tamoxifen should avoid SSRIs, which have been shown to interfere with tamoxifen metabolism 3.
- SNRIs, such as venlafaxine, may be a safer option for women with a history of breast cancer 3.
- Treatment choice should be patient-specific and begin with the lowest dose available 3.
- Adverse events, such as nausea and constipation, are common with SSRIs and SNRIs, but most resolve within the first week of treatment 3.