Nonhormonal pharmacotherapies that are effective in treating postmenopausal vasomotor symptoms include serotonin–norepinephrine reuptake inhibitors such as desvenlafaxine and venlafaxine. In a recent literature review, these pharmacological treatments were found to be safe, efficacious, and well-tolerated.
Approximately 60–80% of menopausal women experience vasomotor symptoms during the initial 7 years of the onset of menopause, which have negative consequences for quality of life. While hormone therapy is the standard prescribed treatment, it is not recommended for all menopausal women. Nonhormonal pharmacotherapies, including selective serotonin reuptake inhibitors (SRRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) have been shown to be effective for reducing the frequency and severity of vasomotor symptoms.
In this study, the authors reviewed evidence supporting the utilization of nonhormonal pharmacological therapies in menopausal women with vasomotor symptoms. The findings are published in the journal Cureus.
Epidemiology of Vasomotor Symptoms in Menopausal Women
The prevalence of menopausal vasomotor symptoms is relatively higher among African American women, whereas Japanese and Chinese women have the least prevalence of vasomotor symptoms. The severity of vasomotor symptoms is associated with obesity, increased abdominal circumference, smoking, lower educational and socioeconomic status, child abuse history, and pre-existing depression and anxiety.
Physiology of Vasomotor Symptoms
Vasomotor symptoms are known to be caused by a reduction in the thermoneutral zone range. The small changes in the core body temperature elicit sweating and peripheral vasodilation in menopausal women. Decreased estrogen levels are associated with a greater occurrence of vasomotor symptoms. Several other hypotheses have been proposed to explain the underlying mechanisms of vasomotor symptoms in menopausal women.
Hormonal Treatment Contraindications
The hormone therapy options for the management of vasomotor symptoms are categorized into estrogen only and estrogen plus progestin treatment. Hormonal treatment contraindications include history of hormone-dependent cancer, acute hepatic failure, history of deep vein thrombosis, history of cardiovascular disease, migraine headache with aura, and abnormal vaginal bleeding.
Selective Serotonin Reuptake Inhibitors for Vasomotor Symptoms
Paroxetine is the only US Food and Drug Administration-approved SSRI for the management of vasomotor symptoms. However, other SSRIs, such as sertraline, fluoxetine, citalopram, and escitalopram, have been shown to have similar benefits in menopausal women. SSRIs have mild adverse effects such as nausea, vomiting, sexual dysfunction, insomnia, headaches, and agitation.
Serotonin–Norepinephrine Reuptake Inhibitors for Vasomotor Symptoms
Venlafaxine is an SNRI that has been shown to have comparable efficacy to that of estradiol in the management of vasomotor symptoms in menopause. This drug is associated with early improvements in vasomotor symptoms in women with a history of breast cancer. Despite the use of SNRIs in the treatment of menopause-associated vasomotor symptoms, they may cause impaired sexual function; hence, the treatment regimen should be tailored accordingly.
Source:
Witten, T., Staszkiewicz, J., Gold, L., Granier, M. A., Klapper, R. J., Lavespere, G., Dorius, B., Allampalli, V., Ahmadzadeh, S., Shekoohi, S., Kaye, A. D., & Varrassi, G. (2024). Nonhormonal pharmacotherapies for the treatment of postmenopausal vasomotor symptoms. Curēus, 16(1). https://doi.org/10.7759/cureus.52467
