Women's Health

Women's Health

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April 2011

Antidepressant may reduce severity,
frequency of menopausal hot flashes

Women who took the antidepressant escitalopram during the menopausal transition or post-menopause had less frequent and severe hot flashes than women who received a placebo, a new study reports in a recent issue of the Journal of the American Medical Association.

What the news means to you

Some alternatives exist to hormone therapy.

By Mary Jane Minkin, MD, FACOG

Learn more

In this eight-week study, 205 healthy women received a 10 mg daily dose of escitalopram or a placebo for four weeks. If at the end of four weeks the women did not report at least a 50 percent reduction in hot flashes or a decrease in severity, their dosage was increased to 20 mg of the study drug or matched placebo.

Researchers observed a significant drop in frequency and severity of hot flashes in the escitalopram group compared with the placebo group.

"Our findings suggest that among healthy women, 10-20 mg per day of escitalopram provides a nonhormonal, off-label option that is effective and well-tolerated in the management of menopause hot flashes," the authors write. The average frequency of hot flashes at the beginning of the study was 9.8 per day. It decreased by 47 percent to an average of 5.26 per day at week eight in the escitalopram group, compared with a 33 percent decrease to 6.43 hot flashes per day in the placebo group. The severity also decreased significantly in the escitalopram group compared with placebo.

Women taking escitalopram showed markedly greater clinical improvement — defined as a decrease in hot flash frequency of 50 percent or more from baseline frequency — at week eight than women taking placebo (55 percent versus 36 percent, respectively).

"The three-week post-intervention follow-up demonstrated that hot flashes increased after cessation of escitalopram but not after cessation of placebo, providing further evidence of escitalopram's effects," the authors write.

What the news means to you

With the onset of menopause, symptoms can include general achiness, mood and cognitive issues, and libido issues. Most women experience sleep disturbances and many will develop vaginal dryness. Eighty percent of women get hot flashes during menopause, with about 20 percent experiencing severe hot flashes and the other 60 percent are of a more moderate nature.

When considering hormone therapy (HT) for menopause, the majority of women are concerned about the risk of blood clots and breast cancer. For women on estrogen only (those who have had a hysterectomy), there doesn't seem to be any increased breast cancer risk, at least for the first seven years of therapy. For women on estrogen plus progestin, there is probably a slight increased risk of breast cancer after five years.

We have known about the use of antidepressants for menopause treatment (SSRI and SNRI therapy) for years; studies on drugs like escitalopram are just updates. The problem with SSRIs is that some are only about 75 percent as effective as estrogen, while others are only half as effective. In addition, many women cannot tolerate the two main side effects: loss of libido and weight gain. Another medical alternative is gabapentin, but it too comes with side effects including bloating, weight gain and fatigue.

Women are always interested in alternatives to HT, but there is no therapy that can really compete with estrogen for complete relief of hot flashes. However, women who have active thrombophlebitis, breast cancer or have just been treated for a heart attack should avoid hormonal intervention.

Before opting for hormone or alternative therapy, women should explore lifestyle changes. It is helpful to wear layered clothing, sleep in a cold room, and avoid hot flash triggers like red wine and hot coffee. Women should also stop smoking. Smokers have more hot flashes, and they go through menopause earlier. Overweight or obese women also experience more frequent hot flashes and should exercise for weight loss.

There are also some over-the-counter remedies I would suggest. The German brand of black cohosh called Remifemin is not estrogenic, so breast cancer patients can take it, and it works reasonably well for many women. I also recommend soy products, although some oncologists are concerned with breast cancer patients consuming soy.

If a woman suffering from hot flashes and other menopause symptoms has tried over-the-counter remedies, lifestyle changes, is at a good weight and exercises, doesn't smoke and is still uncomfortable, in most cases, I find she will do best with low dose estrogen therapy.

A first step for many women is to gather more information about available treatments for menopause. I recommend online resources such as The North American Menopause Society and Red Hot Mamas, which was founded by a former Yale-New Haven Hospital patient. Since every woman goes through menopause differently, a good health care provider or ob/gyn affiliated with Yale-New Haven Hospital can also answer questions and discuss the right treatment options to consider.

Mary Jane Minkin, MD, FACOG, of Obstetrics, Gynecology & Menopause Physicians, PC, is a clinical professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine.

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