Hutch News

Fred Hutch researchers tackle hot flashes

New study finds antidepressant nearly as effective as low-dose estrogen for cutting back hot flash frequency

May 26, 2014
Effexor

Researchers have found that the antidepressant Effexor and its generic equivalent, venlafaxine, are nearly as effective as low-dose estrogen for fighting hot flashes in menopausal women.

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One minute you’re freezing. The next, you’re the Human Torch. Damp hair has become your signature look and some mornings, you might as well apply your makeup in the shower.

Life in the menopause lane can be a frustrating succession of temperature (and wardrobe) changes as fickle, 50-something bodies flit from one extreme to the other. Hormone therapy is known to be the most effective treatment for hot flashes, but a new study by Fred Hutchinson Cancer Research Center and its research collaborators offers another option for the 80 percent of menopausal women who suffer from hot flashes and night sweats: an antidepressant known as venlafaxine.

“This is definitely good news for women,” said Dr. Katherine A. Guthrie, a biostatistician and menopause researcher in the Hutch’s Public Health Sciences Division. “Women are worried about the side effects and long-term risks of taking hormone treatments. They’re interested in alternatives and at the same time, clinicians recommend that women who do take estrogen take as low a dose as possible. We showed that low-dose estrogen and venlafaxine provide similar benefits.”

The generic version of Effexor, venlafaxine is a serotonin-norepinephrine reuptake inhibitor used to treat depression, anxiety and other mood disorders.  It is one of a handful of antidepressants doctors prescribe off label for menopausal symptoms like hot flashes and night sweats.

In the study, published Monday in JAMA Internal Medicine, researchers showed that venlafaxine performed well when compared to low-dose estrogen, an effective but fraught treatment for hot flashes and night sweats.

“Since the publication of the Women’s Health Initiative findings, which demonstrated risks associated with ET (estrogen therapy) and led to our current recommendations, that ET be used only at the lowest possible dosage for the shortest possible duration, there has been increased interest in non-hormonal treatments,” said lead author Dr. Hadine Joffe, who partnered with the Hutch on the study.  “Our new findings provide critical data for physicians and women making treatment decisions for hot flashes and night sweats.”

Joffe directs the Women’s Hormone and Aging Research Program at Brigham and Women’s Hospital in Boston and is among nearly 20 researchers involved with the study, part of a series of National Institutes of Health-funded studies known as MsFLASH, or Menopause Strategies: Finding Lasting Answers for Symptoms and Health. Fred Hutch is the data coordinating center for MsFLASH, which involves five clinical research centers across the U.S.; Hutch researchers who participated in the study include Guthrie and Dr. Andrea LaCroix, both co-directors of the MsFLASH Data Coordinating Center; and Drs. Garnet Anderson and Julie Hunt, all of the PHS Division.

This latest MsFLASH study recruited a total of 339 racially diverse, peri- and postmenopausal women who suffered from bothersome hot flashes and night sweats – known as vasomotor symptoms or VMS. Each participant was given an identical pill each day for eight weeks; 96 received a low-dose estrogen pill, 97 received venlafaxine and 146 received a placebo.

Viable alternative to hormone therapy

At the end of the eight weeks, data showed that the women who took low-dose estrogen experienced a 53 percent reduction in VMS frequency while the women who took venlafaxine reduced their hot flashes and night sweats by 48 percent. Those in the placebo group experienced a 29 percent reduction in vasomotor symptoms.

According to the study, both interventions were well tolerated and were found to be effective for VMS in midlife women.

“While efficacy of low-dose estradiol (estrogen) may be slightly superior to that of venlafaxine, the difference is small in magnitude and of uncertain clinical relevance,” the authors concluded.

Guthrie stressed that women should discuss treatment options with their doctors but said antidepressants were a viable alternative for alleviating menopause symptoms, especially for women unwilling or unable to use hormone therapy because of health risks.

In 2002, the Women’s Health Initiative – based at Fred Hutch – halted a long-term clinical trial examining the health benefits of hormone therapy after finding the most popular treatment for menopause – a pill that combined estrogen and progesterone – increased the risk of breast cancer, heart disease, stroke, blood clots, dementia and other health problems. The study also found estrogen alone was associated with an increased risk of stroke.

Antidepressants do not appear to carry those risks.

“These kinds of medicines have been prescribed for a long time, doctors are comfortable using them and, even though they’re not FDA approved for these applications, they have minimal side effects and are not known to have any long-term risks like breast cancer,” Guthrie said, adding that long-term studies of venlafaxine as a non-hormonal treatment for menopausal symptoms are still needed.

Another boon for women looking for a non-hormonal treatment option: venlafaxine is a generic.

“That was important to us,” Guthrie said. “It gives women an option that’s not expensive.”

The MsFLASH group is also conducting research into midlife women’s sexual function and vaginal health in hopes of addressing other post-menopausal symptoms such as loss of libido and vaginal dryness.  

“We’d like to feel that we’re empowering women by providing evidence-based information,” she said. “That’s our goal.”

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Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has also written extensively about health issues for nbcnews.com, TODAY.com, CNN.com, MSN.com, Columns and several other publications. She also writes the breast cancer blog, doublewhammied.com.Reach her at dmapes@fredhutch.org.

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