SSRIs and SNRIs
Prescribed non HRT medications such as selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressant medicine. They include Paroxetine, Fluoxetine, Escitalopram and Citalopram. Several years ago it was noticed as an unexpected benefit that menopausal women who took these medicines for depression had fewer hot flushes. Since then, a few studies have shown that several SSRIs stop or reduce hot flushes in some menopausal women, even those who are not depressed. A similar antidepressant drug called Venlafaxine, a serotonin and noradrenaline (norepinephrine) reuptake inhibitor (SNRI) antidepressant, has also been shown to have this effect. How SSRIs and SNRIs work to help hot flushes is not clear. A greater reduction in hot flushes is seen at higher doses but the possible side-effects including nausea, reduced sex drive, sleep problems, dizziness and confusion can be worse.
Note: They have been widely used effectively for reducing hot flushes in women who have had breast cancer, however, you should not take Paroxetine or Fluoxetine if you are also taking Tamoxifen as these medicines can interfere with the action of Tamoxifen. Venlafaxine is the preferred option in this situation.
Note: The 2015 NICE guideline recommended that SSRIs should not be routinely offered for the control of menopause symptoms including those related to mood.
Gabapentin is a medicine that is usually used to control epileptic seizures and pain. However, research has shown that it can ease flushing, aches and pains and paraesthesia symptoms in some menopausal women. Possible side-effects include dizziness, tiredness, weight gain and tremor. Side effects can be reduced by starting at a low dose and gradually increasing.
Note: The 2015 NICE guideline did not recommend the use of this drug for the treatment of menopause symptoms.
Note: strictly speaking, SSRIs, SNRIs and Gabapentin are not licensed for treating menopausal symptoms. However, many doctors are willing to prescribe one of these treatments, with the patient’s consent, to see if it works.
NICE 2015 Guideline
You can download a copy of the NICE guideline which offers clarity to both healthcare professionals and women on the diagnosis and treatment of menopause symptoms.
The NICE guideline prepared for healthcare professionals: https://www.nice.org.uk/guidance/NG23
There is a simplified version for women patients which you can find here: http://www.nice.org.uk/guidance/ng23/ifp/chapter/About-this-information
Natural Progesterone Cream
In the UK, natural progesterone cream is only available on a private prescription and is used in varying strengths. Some individuals believe that the replacement of progesterone rather than oestrogen is needed at menopause but most experts believe that the symptoms of menopause are due to lack of oestrogen and therefore the main hormone to replace should be estrogen, with forms of progesterone only being needed to protect the womb lining from stimulation by estrogen. Progesterone cream has been shown to be of some help in the relief of flushes and sweats at menopause, although studies have shown that the circulating level of progesterone in the blood are variable and very low. This could be a placebo effect. Progesterone cream is definitely not suitable for providing protection to the womb lining.
There are also claims that natural progesterone cream can offer bone protection but the National Osteoporosis Society funded a study into these claims and they have not been confirmed. Therefore any individual at risk of osteoporosis should not consider this as effective for offering bone protection.
If you choose not to consult a doctor, you can legally import progesterone creams from outside the UK, provided they are solely for your own use. However, it is illegal to supply any product containing progesterone to anyone else in the UK without a prescription. You will find a number of websites offering progesterone cream from America.
Reviewed on: 01/05/2018 by Dr Karen Morton.
Next Review: 01/05/2020
Loprinzi CL, Kugler JW, Sloan JA et al. Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet 2000; 356:2059-2063.
N.Biglia, R.Torta, R.Roagna, F Maggiorotto, F. Cacciari, R.Ponzone, F. Kubatzki, P.Sismondi.
Evaluation of low-dose venlafaxine hydrochloride for the therapy of hot flushes in breast cancer survivors. Maturitas. Volume 52, issue1, pages 78-85.Sept 2005.
Guttuso T Jr, Kurlan R, McDermott MP et al. Gabapentin’s effects on hot flashes in postmenopausal women: a randomized controlled trial. Obstet Gynecol 2003; 101:337-345.
Gabapentin vs. low-dose transdermal estradiol for treating post-menopausal women with moderate to very severe hot flushes; Aguirre W, Chedraui P, Mendoza J, Ruilova I; Gynecological Endocrinology (Jan 2010)