Two Options To Reduce Hot Flashes

Both estrogen and venlafaxine reduced hot flashes in perimenopausal and menopausal women

(RxWiki News) Menopause can bring on some uncomfortable symptoms, including hot flashes. While hormone therapy is the gold standard of treatment for these symptoms, another medication may also bring relief to menopausal women.

In a recent study, both estradiol, an estrogen medication, and venlafaxine (brand name Effexor) reduced hot flashes.

Estradiol and venlafaxine are currently available on the market as treatments for symptoms of menopause.

"Tell your doctor if you're having hot flashes and night sweats."

This study was led by Hadine Joffe, MD, MSc, of Brigham and Women’s Hospital at Harvard Medical School in Boston.

The researchers looked at 339 women who were menopausal (a year or more since last menstruation or had both ovaries removed), were perimenopausal (not yet menopausal but didn't have a menstrual period for 60 days or more in the previous year), or had hormone levels showing they were done with menstruation.

During menopause, when estrogen levels drop and gonadotropin-releasing hormone levels surge, many women experience unpleasant symptoms, such as vaginal dryness or depression. Among the most common and least pleasant symptoms are vasomotor symptoms, which indicate that the body cannot regulate its temperature properly. Women with vasomotor symptoms typically experience hot flashes or night sweats.

All the women in this study were 40 to 62 years of age, and experienced at least two bothersome vasomotor symptoms per day. The women averaged 8.1 unpleasant episodes per day. All of the women were part of the MsFLASH (Menopause Strategies: Finding Lasting Answers for Symptoms and Health) study sites, which are funded by the National Institutes of Health.

The women came in for three clinic visits, and received two telephone assessments. They also completed questionnaires and recorded their vasomotor symptoms and menstrual bleeding.

The women enrolled between December 5, 2011 and October 15, 2012. Each woman was randomly assigned to receive low-dose estradiol (0.5 milligrams per day), placebo (fake medication) daily, or a daily dose of low-dose venlafaxine hydrochloride (75 milligrams per day) for eight weeks.

Venlafaxine is part of a class of medications called selective serotonin reuptake inhibitors (SSRIs). SSRIs are usually used as antidepressants, but have been shown to help ease vasomotor symptoms as well. Venlafaxine was recently approved by the US Food and Drug Administration (FDA) for vasomotor symptom control.

In this study, 97 women took the estradiol, 96 women received venlafaxine, and 146 women were placed on placebo.

By the end of eight weeks, the women taking estradiol reported the fewest vasomotor symptoms — about 3.9 per day. Women on venlafaxine had 4.4 vasomotor symptoms per day, and women on placebo reported 5.5 symptoms daily.

The women rated their satisfaction with treatment, and more than 70 percent on estradiol were pleased with their treatment. This was also true for about 51.1 percent of women taking venlafaxine and 38.4 percent on placebo.

The women did not report many negative effects from any treatment, although venlafaxine has been shown to increase blood pressure in some women. Estradiol is also not indicated for some women, such as those with a history of breast cancer.

"Low-dose oral estradiol and venlafaxine were effective and well-tolerated treatments for perimenopausal and postmenopausal women with bothersome [vasomotor symptoms]," the authors concluded. "Treatment decisions should weigh the risk profile of each agent for each individual woman, taking into account her risk factor status and personal preferences regarding treatment options.”

This study was published online May 26 in JAMA Internal Medicine.

The authors disclosed several potential conflicts of interest, including funding from various pharmaceutical companies.

Review Date: 
May 29, 2014