Medically reviewed by Dr. Jyothi Shenoy, MD, Written by Swati Pund, PhD
What causes hot flashes or vasomotor symptoms?
A sudden feeling of warmth with sweating during the perimenopause and menopause phases can be discomforting.
Millions of women around the world experience hot flushes/flashes and night sweats for 7 years or more. These are vasomotor symptoms related to blood flow through small blood vessels.
Alternatives to Menopause Hormone Therapy
If you cannot take menopause hormone therapy, there are still many ways to manage vasomotor symptoms. Don’t just sit and suffer. Non-hormonal drugs could help those who cannot take hormonal therapies.
Antidepressants, Gabapentin, Fezolinetant, and Oxybutynin are recommended for the treatment of vasomotor symptoms in the US, while the menopause practitioners in the UK usually prescribe Gabapentin, Pregabalin, Clonidine, antidepressants, and Fezolinetant.
Always ask your doctor in your local area what is available and suitable to you.
Here are a few options that your doctor may prescribe to reduce the severity or frequency of vasomotor symptoms:
Antidepressants (SSRIs and SNRIs)
The antidepressants belonging to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) reduce the frequency and severity of vasomotor symptoms.
Among these, Paroxetine (Brisdelle) is the only one approved by the FDA for treating moderate to severe vasomotor symptoms. It also helps with sleep problems.
Other SSRIs and SNRIs that can be used for vasomotor symptoms include escitalopram (Lexapro), citalopram (Celexa), venlafaxine (Effexor XL), and desvenlafaxine (Pristiq). These medications cannot be prescribed to patients with mental health issues or using drugs such as monoamine oxidase inhibitors.
Gabapentin
An FDA-approved drug to treat seizures, Gabapentin has been prescribed for people who cannot take menopause hormone therapy.
It has been shown to reduce the frequency and severity of vasomotor symptoms and helps improve sleep quality and lessen pain. Taking medication at bedtime might be a good option for women who have trouble sleeping, since drowsiness can be a side effect. Gabapentin has several side effects such as dizziness, headache, disorientation, dry mouth, and weight gain.
Veozah (Fezolinetant)
Fezolinetant, is a newer addition to the treatment of vasomotor symptoms. It regulates our body’s temperature regulation mechanism that triggers hot flushes/flashes.
It is safe and effective, but frequently shows headache as its primary adverse effect. Fezolinetant is the FDA-approved drug for vasomotor symptoms in the US. It is available for private prescription in the UK.
Oxybutynin
Recommended by the American Menopause Society because Oxybutynin is an effective drug for both hot flushes/flashes and urinary issues. It is typically used to treat the sudden and uncontrollable urge to urinate (Overactive bladder and urge incontinence).
Oxybutynin treatment may have side effects such as dry mouth and eyes, stomach pain, nausea, and headache. Long-term use may be linked to cognitive decline, especially in older adults.
Clonidine
A widely used medication for lowering blood pressure because it relaxes your blood vessels. It has shown to modestly reduce hot flushes/flashes; however, it causes several side effects that include dry mouth, lowering of blood pressure, nausea, and fatigue and not recommended in the US
At higher doses, it can cause sleep disturbance in at least half of the users. It is a licensed non-hormonal drug for the indication of hot flushes/flashes in the UK.
Pregabalin
This anti-seizure drug has similarities with Gabapentin and was originally prescribed for nerve-related pain and seizures. However, there is limited data for its use in hot flushes/ flashes.
In the UK, Pregabalin is an alternative to MHT for the management of hot flushes/flashes. But US healthcare practitioners do not recommend the use of pregabalin for vasomotor symptoms, as it may lead to abuse, dizziness, thinking and memory-related difficulties, and weight gain.
Resources for you
Read more on the websites of menopause societies and scientific articles.
Don’t suffer in silence, use Sol to find a doctor who can discuss suitable treatments for you.
References
Avis, N. E. et al. (2015). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med, 175(4), 531-539. https://doi.org/10.1001/jamainternmed.2014.8063
Yoon, S. H. et al. (2020). Gabapentin for the treatment of hot flushes in menopause: a meta-analysis. Menopause, 27(4), 485-493. https://doi.org/10.1097/gme.0000000000001491
Shufelt, C. L. et al. (2023). The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause: The Journal of the North American Menopause Society, 573–590. https://doi.org/10.1097/GME.002200
Depypere, H. et al. (2021). Fezolinetant in the treatment of vasomotor symptoms associated with menopause. Expert Opin Investig Drugs, 30(7), 681-694. https://doi.org/10.1080/13543784.2021.1893305
Leon-Ferre, R. A. et al. (2020). Oxybutynin vs Placebo for Hot Flashes in Women With or Without Breast Cancer: A Randomized, Double-Blind Clinical Trial (ACCRU SC-1603). JNCI Cancer Spectr, 4(1), pkz088. https://doi.org/10.1093/jncics/pkz088
Freedman, R. R. (2014). Menopausal hot flashes: mechanisms, endocrinology, treatment. J Steroid Biochem Mol Biol, 142, 115-120. https://doi.org/10.1016/j.jsbmb.2013.08.010
British Menopause Society. (2023). Complementary & alternative therapies: Non hormonal treatments for menopause symptoms. https://www.womens-health-concern.org/wp-content/uploads/2023/11/03-WHC-FACTSHEET-Complementary-And-Alternative-Therapies-NOV2023-C.pdf