Medications

Other Drugs Used for Menopausal Symptoms

Despite its risks, hormone replacement therapy appears to be the best treatment for hot flashes. Nonhormonal treatments for hot flashes and other menopausal symptoms include:

Antidepressants. The antidepressants known as selective serotonin-reuptake inhibitors (SSRIs) are sometimes used for managing mood changes and hot flashes. They include fluoxetine (Prozac), sertraline (Zoloft), venlafaxine (Effexor), and paroxetine (Paxil, Asimia). A 2006 review of nonhormonal therapies, found that paroxetine in particular may help hot flashes. However, paroxetine, like other antidepressants, can cause headache, anxiety, and sexual problems.

Gabapentin.Several small studies suggest that gabapentin (Neurontin), a drug used for seizures and nerve pain, may relieve hot flashes. Gabapentin may cause drowsiness, dizziness, fatigue, and swelling of the hands and feet.

Clonidine. Clonidine (Catapres) is a drug used to treat high blood pressure. Studies show it may help manage hot flashes. Side effects include dizziness, drowsiness, dry mouth, and constipation

Testosterone. Some doctors prescribe combinations of estrogen and small amounts of the male hormone testosterone to improve sexual function and increase bone density. Side effects of testosterone include increased body hair, acne, fluid retention, anxiety, and depression. It also adversely affects cholesterol and lipid levels. Long-term benefits or other risks are unknown.

Drugs to Prevent and Treat Osteoporosis

After menopause, a woman is at increased risk osteoporosis. Certain drugs may be prescribed to help prevent bone loss. [For more information on osteoporosis prevention and treatment, see In-Depth Report #18: Osteoporosis.]

Selective Estrogen-Receptor Modulators (SERMs). SERMS are designed to produce the benefits of estrogen, such as bone protection, without its risks. They are thought to act like estrogen in some tissues but behave like estrogen blockers (antiestrogens) in others.

The only SERM prescribed for menopausal conditions is raloxifene (Evista). It is prescribed for prevention and treatment of osteoporosis in post-menopausal women. Raloxifene also decreases LDL ("bad") cholesterol levels, but does not appear to increase HDL ("good") cholesterol.