What are the most effective medications for treating hot flashes in menopause?

From the Guidelines

Venlafaxine is the most effective non-hormonal medication for treating hot flashes in menopause, as recommended by the American Cancer Society and American Society of Clinical Oncology 1. The treatment of hot flashes in menopause can be approached through various methods, including hormonal and non-hormonal medications, as well as lifestyle modifications. For non-hormonal options, certain antidepressants have shown effectiveness, particularly venlafaxine (37.5-75mg daily) 1, which has been found to be safe and effective in reducing hot flashes. Other alternatives include gabapentin (300-900mg daily) and selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (7.5-20mg daily) 1. However, there is concern that SSRIs that inhibit the CYP2D6 enzyme pathway, such as paroxetine, may reduce the conversion of tamoxifen to active metabolites 1. Lifestyle modifications like avoiding triggers (spicy foods, alcohol, caffeine), dressing in layers, keeping your bedroom cool, and practicing relaxation techniques can complement medication therapy 1. It is essential to discuss your medical history with your doctor before starting any treatment, as some options may be contraindicated depending on your health status. Some studies suggest that acupuncture and environmental modifications can also be helpful in reducing hot flashes 1. In general, treatment should be individualized and based on the severity of symptoms, patient preferences, and medical history. The goal of treatment is to improve quality of life by reducing the frequency and severity of hot flashes, while also considering the potential risks and benefits of each treatment option 1. Key considerations include:

• The effectiveness of different medications and lifestyle modifications in reducing hot flashes
• The potential risks and benefits of each treatment option
• The importance of individualizing treatment based on patient preferences and medical history
• The need to discuss treatment options with a healthcare provider to determine the best course of treatment.

From the FDA Drug Label

Estradiol is used to: reduce moderate to severe hot flashes Estrogens are hormones made by a woman's ovaries Between ages 45 and 55, the ovaries normally stop making estrogens. This leads to a drop in body estrogen levels which causes the “change of life” or menopause When the estrogen levels begin dropping, some women develop very uncomfortable symptoms, such as feelings of warmth in the face, neck, and chest, or sudden strong feelings of heat and sweating (“hot flashes” or “hot flushes”). For treatment of moderate to severe vasomotor symptoms, vulval and vaginal atrophy associated with the menopause, the lowest dose and regimen that will control symptoms should be chosen and medication should be discontinued as promptly as possible. The usual initial dosage range is 1 to 2 mg daily of estradiol adjusted as necessary to control presenting symptoms.

Estradiol is an effective medication for treating hot flashes in menopause, as it helps to reduce moderate to severe hot flashes by replacing the estrogen hormones that the ovaries stop making during menopause 2. The recommended dosage is 1 to 2 mg daily, adjusted as necessary to control symptoms 2.

• Key points:
  • Estradiol is used to reduce moderate to severe hot flashes
  • The usual initial dosage range is 1 to 2 mg daily
  • Medication should be discontinued as promptly as possible once symptoms are controlled
  • Treatment should be cyclic (e.g., 3 weeks on and 1 week off) 2

From the Research

Effective Medications for Hot Flashes in Menopause

The most effective medications for treating hot flashes in menopause include:

• Hormone therapy, specifically combined estrogen/progestogen therapy, which is recommended for women with a uterus to treat menopausal symptoms such as vasomotor symptoms (hot flashes) and vaginal atrophy, using the smallest effective dosage for the shortest possible duration 3
• Estrogen therapy, which is considered the most effective treatment for hot flashes, but should be used with caution and under the guidance of a healthcare provider due to potential risks such as breast cancer and cardiovascular disease 3, 4
• Nonhormonal alternatives such as:
  • Low-dose paroxetine, which has been shown to be effective in reducing hot flash frequency and severity 5, 6
  • Venlafaxine, which has been shown to be effective in reducing hot flash frequency and severity 3, 6
  • Gabapentin, which has been shown to be effective in reducing hot flash frequency and severity 3, 4
• Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), which have been shown to be effective in reducing hot flash frequency and severity, with escitalopram, paroxetine, and fluoxetine being the most effective SSRIs, and venlafaxine and desvenlafaxine being the most effective SNRIs 6

Considerations for Treatment

When considering treatment options for hot flashes in menopause, it is essential to:

• Weigh the potential benefits and risks of hormone therapy, including the increased risk of breast cancer and cardiovascular disease 3, 4
• Use the lowest effective dose of hormones for the shortest possible duration 3, 4
• Consider nonhormonal alternatives, such as SSRIs and SNRIs, for women who cannot tolerate hormone therapy or have contraindications to its use 3, 6
• Monitor patients closely for adverse effects and adjust treatment as needed 3, 4