Hormones for Hot Flashes

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

The FDA approved the first and only non-hormonal treatment for hot flashes in 2013. Brisdelle (paroxetine) belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). These medications are used primarily to treat depression. Before Brisdelle was approved, estrogens were the only FDA-indicated treatment for hot flashes.

A new study highlights an increased risk for bone fractures in women taking SSRIs for non-psychiatric conditions like hot flashes. Statistics from an insurance claims database indicate that female patients, aged 40-64 without mental illness who started SSRIs from 1998-2010, had an increased risk of breaking a bone compared to a similar group that started using proton pump inhibitors for stomach disorders. It may be time to reevaluate the use of SSRIs for the treatment of hot flashes.

Estradiol is FDA-approved for the treatment of hot flashes as well as for the prevention of osteoporosis. Misinterpretation of the Women’s Health Initiative (WHI) Study has generated apprehension regarding the use of bioidentical hormone replacement therapy (BHRT) for hot flashes.

Dr Kent Holtorf has reviewed numerous published papers and concluded that BHRT is safer and more effective than conventional hormone replacement therapy. Individualizing therapy and balancing hormone benefits vs risks is the key to successful management of menopausal hot flashes. There is no need to substitute an SSRI for the real-deal.

Read more in the Women’s International Pharmacy Connections Newsletter on Menopause.

  • Sheu YH, et al. SSRI use and risk of fractures among perimenopausal women without mental disorders. Inj Prev. 2015 Jun 25. doi: 10.1136/injuryprev-2014-041483. (Epub ahead of print)
  • Holtorf K. The Bioidentical Hormone Debate:  Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? Postgrad Med. 2009 Jan;121(1):1-13.