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Determining the Best Candidates for Nonhormonal Hot Flash Treatment

By HERWriter
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Doctor discusses notes with patient Photographee.eu/fotolia

Most gynecologists agree that many women are excellent candidates for the “lowest effective dose of hormone therapy” for treating the miseries of hot flashes. But when a woman is excluded from that club due to one of a handful of medical conditions or is unsettled by the idea of hormone therapy, a different class of drugs can help fizzle the flashes.

Selective serotonin reuptake inhibitors, or SSRIs, are classified as antidepressants but have been used for a long time to treat hot flashes.

Women who suffer from estrogen-receptor-positive cancers, those with active lung disease or a history of blood clots, particularly those associated with pregnancy, and women who show a high risk for breast cancer are not considered good candidates for traditional hormone therapy and may turn to SSRIs as their only other prescription-based option.

And then there are simply the ladies who have been turned off to the idea of hormone therapy by conflicting media reports. By all means, they make up a legitimate candidate pool of hot flash sufferers who should give SSRIs a go says North American Menopause Society Founder and Executive Director Wulf Utian, M.D.

“They are terrified. If it’s going to make you worry and you’re scared, don’t take it,” said Utian about hormone therapy.

When it comes to SSRI use, Utian, who is professor emeritus of Reproductive Biology at Case Western University in Cleveland, Ohio, explains there are two categories: prescription products approved by the Food and Drug Administration (FDA), of which there is only one (paroxetine, approved in 2013), and prescriptions not approved by the FDA for those particular uses. The prescribing of non-approved SSRIs is referred to as off-label use.

Utian explained the prescribing of non-FDA-approved SSRIs for the treatment of hot flashes is perfectly legal and accepted – patients simply wouldn’t have any recourse in a court of law should they claim they suffered harm using a non-approved drug for hot flashes.

“There are a lot. I don’t know them all,” Utian said of all the SSRIs available. “It was the low-dose paroxetine that was taken through the approval process.”

In its comprehensive online brochure Menopause Map: My Personal Path, The Endocrine Society says SSRIs are an excellent option for women suffering from both depression and hot flashes. However, they do caution the side effects can include mood changes and a decrease in sex drive.

The brochure also points out that some types of SSRIs should be used with caution in women who have had breast cancer. For example, Tamoxifen, a common drug used to prevent the recurrence of breast cancer can have adverse reactions with paroxetine and sertraline hydrochloride.

As for effectiveness: Utian says on a scale of one to 10, placebos are found to have an effectiveness rating of 3.5 to 6 while SSRIs are rated up to 6.5 and hormone therapy rates 9.7 to 9.8.


Wulf Utian, M.D., via phone conversation September 15, 2015. http://www.utianllc.com/about/

Menopause Map: My Personal Path. Menopause Map Interactive Guide. P 37. Hormone Health Network. Retrieved September 15, 2015. http://mypersonalpath.com/gtg

Reviewed September 30, 2015
by Michele Blacksberg RN

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.


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