The FDA recently approved Brisdelle, the first non-hormonal medication for hot flashes associated with menopause. This may be exciting news for women wishing to avoid hormonal options for their hot flashes.
But, before you take on a new medication, consider the side effects and other options (including bio-identical hormone replacement) to see if Brisdelle is your preferred option.
The drug is named Brisdelle (paroxetine). It is really a slightly lower dose of the commonly used SSRI antidepressant Paxil. Brisdelle is given at a 7.5 mg dose, while Paxil is usually started at a dose of 10 mg. Menopausal women in the clinical trials saw a significant reduction in their hot flashes, along with improved sleep.
Side Effects of Brisdelle
Side effects commonly seen with SSRI’s include weight gain, decreased sex drive and flattened affect – meaning while people don’t feel depressed, they also don’t feel very happy either – they just feel flat.
Weight gain, low sex drive and a flat mood don’t seem like great trade offs when trying to get rid of hot flashes, especially if hormones may fix not only the hot flashes but a whole host of other symptoms. It is most likely that women who are suffering from hot flashes have an estrogen or progesterone deficiency, not a paroxetine deficiency.
I’d encourage women to evaluate bio-identical hormonal options, since deficient and imbalanced hormones are the reason they are getting hot flashes in the first place.
Bio-Identical Hormone Replacement for Hot Flashes
Estrogen replacement is extremely effective for reduction of hot flashes. It helps with mood, weight management, and sex drive in women who are estrogen deficient.
Women who are progesterone deficient may also have hot flashes. And for those women, progesterone supplementation (not progestin – the artificial form of progesterone) will not only help improve their hot flashes, but also improve their mood, decrease anxiety, improve sleep, and help with weight loss, memory and energy.
Studies show that estrogen and progesterone replacement has other health benefits as well, including benefits for the heart, blood vessels, brain and bones of women.
Tamoxifen and Brisdelle
Women who have survived breast cancer might be targets of non-hormonal medications for hot flashes. But if you are undergoing Tamoxifen therapy for breast cancer, Brisdelle (paroxetine) may not be appropriate. Paroxetine may reduce the effectiveness of Tamoxifen, so most clinicians do not use this combination.
Other medications that may be considered if hormones are not an option for you include venlafaxine, citalopram, clonidine and gabapentin, but each of these have their own side effects as well.
Hormone Therapy: Educate Yourself
The scientific evidence supporting the treatment of women with hormone therapy is changing frequently and the advice is changing rapidly. In July 2013, Yale researchers concluded that stopping hormone therapy due to controversies about hormones may have contributed to 50,000 deaths from cardiovascular disease, deaths that may have been prevented had women continued hormone therapy.
It’s extremely important for women to become educated and become active participants in the therapy that is chosen for them. The evidence is confusing and a visit to a hormone specialist may be the best way to figure out what the best answer for each woman may be.