Eighty percent of women experience hot flashes—sudden waves of uncomfortable heat that usually start at the head and spread throughout the body—at some time during menopause.
According to a recent study published in the Journal of the American Medical Association (JAMA), Lexapro (escitalopram), a selective serotonin reuptake inhibitor (SSRI) antidepressant, was found to reduce the frequency and severity of hot flashes in menopausal and postmenopausal women. The 205 women in the multi-center, randomized trial received 10 to 20 milligrams daily of escitalopram or a placebo for 8 weeks.
On average, women reported experiencing 9.8 hot flashes per day at the beginning of the study, but by week eight, the Lexapro group reported having 5.26 hot flashes per day, compared to 6.43 hot flashes per day in the placebo group. The Lexapro group also had less severe hot flashes.
“SSRI’s reduce hot flashes, but they are not going to eliminate them,” says Lauren Streicher, M.D., an assistant clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine in Chicago, and the author of The Essential Guide to Hysterectomy. Other antidepressants that may reduce hot flashes include fluoxetine (Prozac), paroxetine (Paxil, Paxil CR), and venlafaxine (Effexor). Selective serotonin reuptake inhibitors (SSRIs) affect the brain’s use of serotonin, a neurotransmitter chemical that’s thought to have a role in regulating body heat.
However, antidepressants are less effective at treating hot flashes than estrogen replacement therapy, says Dr. Streicher. In addition, using SSRIs to treat menopause symptoms is considered an off-label or unofficial use for the medications. (Once the FDA approves a drug for one purpose, doctors can legally prescribe it for any other medical condition. For example, antidepressants are frequently prescribed off-label to treat migraine headaches and other painful conditions.) Women with hot flashes should discuss the potential risks and benefits of the SSRIs, estrogen replacement therapy, and other treatments with their doctor, to make an informed decision about which menopause therapy is right for them.
“There are women who can’t take estrogen or choose not to, and then we look for alternatives,” says Dr. Streicher. “The SSRI’a have been known to reduce hot flashes, but have not been FDA-approved. I prescribe them in low doses for people who can’t or choose not to take estrogen.”
Hormonal therapy has been the predominant therapy for hot flashes but its use decreased when results of the Women’s Health Initiative suggested that the risks of hormone treatment, including heart disease and breast cancer, outweighed the benefits. However, no other treatments for menopausal hot flashes have U.S. Food and Drug Administration approval.
As for natural remedies for hot flash treatment, more research needs to be done. “Herbs and botanicals (black cohosh, soy products) have not been shown to work beyond the placebo effect,” says Dr. Streicher. “There are no scientific studies that prove they work—natural doesn’t mean safe.”
Avoiding triggers such as, alcohol, spicy food, tight clothes, stress, caffeine, heat and cigarette smoke, may help prevent or reduce hot flashes. Doctors also recommend exercising daily and practicing deep abdominal breathing in the morning and evening. “A lot of women think they are not candidates for low-dose estrogen therapy but they are,” says Dr. Streicher. “It is important to see a doctor who truly is an expert in menopause.”
CONNECT THE DOTS
The North American Menopause Society’s (NAMS) website offers a physician finder so to locate a doctor that specializes in menopause. Find more menopause resources at The National Institutes of Health and the Mayo Clinic.
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