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Nonhormonal management of menopausal vasomotor symptoms (VMS) continues to garner interest; however, study results have shown that such approaches have had only moderate efficacy, and hormone therapy remains the only FDA-approved treatment for this indication. Investigators randomized 205 perimenopausal or postmenopausal women (age range, 40–62) with ≥28 weekly bothersome hot flashes or night sweats to receive the selective serotonin reuptake inhibitor (SSRI) escitalopram (Lexapro; 10 mg with escalation to 20 mg as needed) or placebo daily for 8 weeks.
At 8 weeks, mean daily hot-flash frequency had declined from 9.8 at baseline to 5.3 in the escitalopram group and 6.4 in the placebo group (P<0.001). No serious treatment-related adverse events requiring study withdrawal occurred. Patient satisfaction with treatment was 70% and 43% in the escitalopram and placebo groups, respectively (P<0.001).
Freeman EW et al. Efficacy of escitalopram for hot flashes in healthy menopausal women: A randomized controlled trial. JAMA 2011 Jan 19; 305:267.
Comment
Several trials of SSRIs for managing vasomotor symptoms have involved breast cancer survivors who have VMS associated with antiestrogen therapy (JW Womens Health Feb 26 2009). Although the authors of this well-conducted study have demonstrated convincingly that escitalopram is more effective than placebo in treating healthy menopausal women with VMS, I expect that its efficacy would not approach that of hormone therapy in a direct comparison. Given the modest efficacy of nonhormonal treatments for VMS, I agree with the perspective voiced by the authors of a recent meta-analysis of such options (JAMA 2006; 295:2057): “These therapies may be most useful for highly symptomatic women who cannot take estrogen but are not optimal choices for most women.”