Can antidepressants prevent perimenopause hot flashes?
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Can antidepressants prevent peri/menopausal hot flashes?
Expert source: Dr. Robert P. Kauffman, MD, MSCP, Professor of Obstetrics and Gynecology and Assistant Dean for Research Education at Texas Tech University Health Sciences Center School of Medicine
Two years into menopause, my hot flashes kicked into high gear.
Night sweats were a minor inconvenience compared to my workday: Sweating profusely and fanning myself — while attempting to teach a class of 30 sixteen-year-olds — was one of the most embarrassing professional predicaments I’ve ever found myself in.
I finally discussed the situation with my primary care doctor at my annual checkup. While she wasn’t comfortable prescribing hormone replacement therapy (HRT), she happily prescribed an antidepressant to treat my hot flashes.
I started out on a very low dose of the antidepressant venlafaxine (brand name Effexor) and was pleased to find relief from the heat waves almost immediately. Fortunately, I didn’t endure any of the common side effects associated with antidepressants, such as nausea, difficulty sleeping or drowsiness, weight gain, dry mouth, or sexual dysfunction. Unfortunately, the drug’s effectiveness began to wane after a couple of months, and my dosage had to be increased.
Again, while I experienced some relief at first, the benefits lagged very quickly. After several months on the medication and two dosage increases, it became clear venlafaxine wasn’t going to be the savior I’d been hoping for.
Antidepressants vs. hormone replacement therapy
When antidepressants proved ineffective against my hot flashes, my doctor prescribed Duavee, a drug that combines estrogen with an estrogen agonist/antagonist, making it less likely than estrogen alone to possibly lead to breast cancer.
Duavee worked extremely well against my hot flashes, with no side effects; however, just a few months into treatment, a Duavee shortage left me unable to fill my prescription. (This problem was later resolved.) My internist, still reluctant to delve into the realm of traditional hormone replacement therapy (HRT), referred me to an OB-GYN, who immediately started me on HRT in the form of estradiol (estrogen) combined with norethindrone acetate (progesterone).
According to Dr. Robert P. Kauffman, MD, MSCP, Professor of Obstetrics and Gynecology and Assistant Dean for Research Education at Texas Tech University Health Sciences Center School of Medicine, hormone replacement therapy “has a high degree of safety and efficacy in those who are within 10 years of menopause [or later in some] and who do not have a contraindication.” I am fortunate to fall into this group, and HRT turned out to be a great option for me; no more night sweats, and no more embarrassing sweat stains on my teacher outfits.
However, HRT is not for everyone, including “breast cancer patients, women with cardiovascular disease, history of thromboembolism [blood clots], known clotting disorders, untreated endometrial hyperplasia/cancer, and advanced cirrhosis.” While this list leaves a not-insignificant number of patients unable to take advantage of HRT — which Dr. Kauffman terms the “gold standard” in hot flash treatment — it is important for this population to explore the many non-hormonal therapies for hot flashes in menopause.
How SSRIs work for hot flashes
There are two types of antidepressants: selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). According to Dr. Kauffman, the way antidepressants work in the brain to combat hot flashes remains largely unknown; however, “it is theorized that hot flashes could be linked to excessive serotonin receptors in the hypothalamus. Accordingly, SSRIs and SNRIs could increase serotonin, the chemical in the brain that promotes feelings of well-being, to bind with those receptors.” Hence, the drugs curb the brain’s menopausal tendency to respond to non-existent heat.
Meet Angie Maguire, an RN and champion for health and wellness in midlife
Chicago • @coachangiern @thernclub • Attending F#ck Middle Age on October 19
I’m a mother of three children (25, 23, and 18), and I have been married 29 years to a Brit. I’ve been a Registered Nurse for nearly 30 years. I have worked in various environments: hospital, clinic, school, and YMCA Camp, and love being a nurse. A year ago, I completed a Nurse Coaching Certification program and became a Nurse Coach, board-certified in June.
I am passionate about working 1:1 with women in midlife around all things health and wellness. I also work with nurses on occupational wellness and have created The Nurse Club, which hosts health and wellness activities for nurses. Through the Nurse Club, I collaborate with other women-owned businesses that donate their time and space and introduce/connect their businesses with nurses. It is a win-win!
I’m in the midst of:
A lot of new things! I am truly in the “next chapter.” I am in the midst of late perimenopause, building a nurse health and wellness coaching business, digging deep into menopause education, and starting to lead an “in-person” Menopause Ed series in October 2024. I am adjusting to an empty nest and lucky enough to be in my parents’ lives, whom I am committed to looking after in the coming years. I have a full plate! That’s what I love and feel grateful for, and good health!
The best thing about my current age, 52:
At 52, the best thing is good health — mentally and physically. After 20 years of running around like a headless chicken, I can stop, breathe, and celebrate my successes and, yes, failures and how I have grown from them. I have time to stop and smell the roses.
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She is the creator and host of the podcast, “You Are Here,” delving into the stories of professionals living on their own terms. Follow Rachel here on LinkedIn, Instagram, and Apple Podcasts.
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