Chapter 11 – Menopause

Non-hormonal pharmacological treatments for menopausal vasomotor symptoms

Non-hormonal medications may be useful if the use of a hormone preparation is contraindicated or not wanted. These include:

Clonidine 25 mcg to 50 mcg bd. Improvements in symptoms would be expected within 4 weeks. Selective Serotonin Reuptake Inhibitors (SSRIs) and Selective Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs): SSRIs, e.g. escitalopram 10-20 mg daily and paroxetine 7.5 mg daily SNRIs, e.g. venlafaxine (75 mg SR per day) and desvenlafaxine (100 mg – 150 mg per day) Note that paroxetine reduces the efficacy of tamoxifen and should not be used in women taking this drug. Unlike the use of these medications for depression, relief of symptoms will be rapid and would be apparent within a month.(51) They may also be useful in patients who present with features of anxiety and depression as well as vasomotor symptoms. Gabapentin 100 mg tds up to 300 mg tds. There may be a reduction in hot flushes within days.

Potential side effects should be discussed. Note that with the exception of clonidine, these non-hormone medications are not TGA approved for use for vasomotor symptoms and are not listed on the PBS for this indication.(51)

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