Nonhormonal treatment for hot flashes approved by FDA

[David Baxter PhD]

Nonhormonal treatment for hot flashes approved by FDA
Mar 1, 2011
Contemporary OB/GYN

Escitalopram (Lexapro; Forest Laboratories Inc, New York, New York), a selective serotonin reuptake inhibitor approved by the US Food and Drug Administration for the treatment of anxiety and depression, significantly reduces the frequency, severity, and bother of hot flashes, according to the findings of a multicenter, 8-week, randomized, double-blind, placebo-controlled trial.

The trial enrolled 205 women aged 40 through 62 years between July 2009 and June 2010. The women were either in menopause transition (ie, amenorrhea for 60 days or more in the past year) or postmenopausal (ie, 12 months or more since last menses or bilateral oophorectomy).

At baseline, the women experienced a mean of almost 10 hot flashes daily. By week 8, the women taking escitalopram 10 to 20 mg per day experienced a mean reduction in hot flash frequency of 4.6 (95% Confidence Interval [CI], 3.74-5.47) per day versus 3.20 (95% CI, 2.24-4.15) for those taking placebo, for a difference of 1.41 per day (95% CI, 0.13-2.69). More than half (55%) of the treatment group versus 36% of the placebo group reported a decrease of at least 50% in hot flash frequency (P=.009) at 8 weeks.

In terms of severity, mean baseline score for all participants was 2.17 on a scale of 1 (mild) to 3 (severe). At week 8, women taking escitalopram had a mean score of 1.63 (95% CI, 1.51-1.76), a 24% decrease, versus 1.89 (95% CI, 1.77-2.02) for the placebo group, a 14% decrease (P<.001).

Similarly at baseline, the mean bother score was 3.14 on a 4-point scale. By week 8, the mean score was 2.48 (95% CI, 2.32-2.64), a 20% decrease, in the treatment group versus 2.76 (95% CI, 2.61-2.91), an 18% decrease, in the placebo group.

Discontinuation because of adverse events was 4% (7 in the active group; 2 in the placebo group). Three weeks after treatment concluded, women in the treatment group reported a mean 1.59 (95% CI, 0.55-2.63; P=.02) more hot flashes daily than women in the placebo group.

Source:
Freeman EW, Guthrie KA, Caan B, et al. Efficacy of escitalopram for hot flashes in healthy menopausal women. JAMA. 2011;305(3):267-274.

 

[ailsa]

Menopause can be unpleasant, that true, but unless the symptoms are unusually severe, it is best to ride it out without drug or hormone therapy. Ten or more flashes a day is about the norm - at least for the women in my family.

Tips. Keep the rooms as cool as possible and supplement with air conditioning and fans. This one action reduces the severity of the experience if not the flash itself.

Carry a small battery-operated fan in your purse and use it.

Take cool showers if possible when one hits or drink icy water.

Keep a fan in the bedroom. Keep a change of nightgown right at bedside. Try to use natural fabric sheets. Bamboo is wonderful at wicking the moisture away from your skin.

Don't diet at this time. A few extra pounds will help since estrogen is stored in fat. Women who are a little bit overweight generally have an easier time. Besides, you will be under enough stress.

For some women, menopause is merely annoying; for some, devastating and can bring on a depression. Sometimes this is tied to changes such as the loss of the reproductive ability, and kids are leaving home at this time or have already gone. You may also be caring for aging parents. Sometimes, it is hormone related. That would be the time to go to the doc and get a treatment plan.

Estrogen therapy was once believed to protect the heart, but this has recently been refuted. My feeling is the company wants to market this drug to as many sources as possible. I suppose it's good to know that help for panic or anxiety that often come with the flashes is available, but it's over quickly and things settle down until the next one. But riding through it naturally also give one time to reflect on what possibilities may open as a result of the change, and also, to come to terms with aging, self image, empty nest etc. My feeling is the drug would mask this opportunity, and also discontinuation may be another unpleasant process to deal with.

Different strokes for different folks though.