Hot flashes, insomnia and mood changes
Common non-hormone options here include SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin-norepinephrine reuptake inhibitors) and anti-epileptics. Read on.
SSRI and SNRI antidepressants
Antidepressants in the SSRI and SNRI drug classes are some of the most effective alternatives to hormone therapy for hot flashes, insomnia and mood changes during menopause. And cool fact: SSRIs and SNRIs tend to work faster for menopause symptoms (days) than for depression (weeks).
The following antidepressants seem to have similarly modest benefits for hot flashes. Since hot flashes eventually go away in postmenopausal women, these antidepressants can be gradually tapered after one to two years.
- Citalopram and escitalopram: Citalopram (Celexa) and escitalopram (Lexapro) are common first-choice drugs to treat hot flashes because they have minimal side effects. The optimal dose for citalopram appears to be 20 mg daily, and for escitalopram, 10 mg daily.
- Paroxetine: Brisdelle, Paxil and Paxil CR each contain paroxetine and come in brand and generic versions. Brisdelle, a low-dose version of Paxil, received FDA approval for the treatment of hot flashes in 2013. Brisdelle (7.5 mg per day), Paxil (10 mg or 20 mg per day) and Paxil CR (12.5 mg or 25 mg per day) have all shown some benefit for hot flashes in studies. Important tip: Brisdelle is more expensive than Paxil and Paxil CR, and is not covered by many insurers.
- Venlafaxine ER: Venlafaxine ER (Effexor XR) is good, but comes with a downside. In a study, venlafaxine ER (75 mg per day) worked just as well as low-dose estradiol (0.5 mg per day) for hot flash relief but caused more nausea and vomiting. Discontinuing venlafaxine can also lead to withdrawal symptoms. To limit nausea, start with 37.5 mg per day of venlafaxine ER and increase the dose to 75 mg per day after a week.
- Desvenlafaxine: Desvenlafaxine succinate ER (Pristiq) works about as well as venlafaxine ER for hot flashes and causes similar side effects.
Anti-epileptics
Anti-epileptic medications like gabapentin (Neurontin) and pregabalin (Lyrica) are another good non-hormone option for women with hot flashes from menopause.
- Gabapentin: Gabapentin (Neurontin) is recommended for women whose hot flashes happen mostly at night. In studies, gabapentin at 900 mg per day (taken as 300 mg three times per day) was more effective than placebo for hot flashes. Gabapentin works as well as venlafaxine at reducing hot flashes.
- Pregabalin: Pregabalin (Lyrica) relieves hot flashes at a recommended dose of 300 mg per day. However, gabapentin is probably a better choice than pregabalin, as gabapentin has been better studied for hot flashes and is less expensive.
Vaginal atrophy
Vaginal dryness, irritation and pain during intercourse (known as dyspareunia) are common symptoms of vaginal atrophy, a hallmark sign of menopause. Vaginal atrophy is where the vaginal tissues become thin as a result of low estrogen levels. Vaginal lubricants, vaginal moisturizers and CO2 laser therapy may be helpful here.
- Vaginal lubricants: Water-, silicone- and oil-based lubricants can be applied before sexual activity to limit discomfort. Lubricants come with risks though. There’s some evidence from research studies that using lubricants can increase your risk for bacterial overgrowth in the vagina (known as bacterial vaginosis) and vaginal yeast infections.
- Vaginal moisturizers: Unlike lubricants, which are used only during sexual activity, moisturizers are used a few days a week regardless of sexual activity to maintain hydration. Replens, available over the counter, is the best-studied vaginal moisturizer and provides long-lasting relief of vaginal dryness. There’s also HYALO-GYN (hyaluronic acid vaginal gel), which, used every three days, can improve vaginal dryness as well as vaginal estrogen therapies.
- CO2 laser therapy: CO2 lasers like the MonaLisa Touch treat vaginal dryness by stimulating vaginal tissue cells to grow new tissue. Laser therapy is effective and long-lasting with very few downsides—except cost. It can cost up to $1000 for one session.
What has worked for you?
Dr O.
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