Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors for menopausal vasomotor symptoms

Abstract

Introduction Some of the most bothersome symptoms associated with menopause are the vasomotor symptoms (VMS), characterized by transient elevations in body temperature associated with a narrowing of the thermoneutral zone and an abnormal firing rate of thermosensitive neurons in the hypothalamus. These VMS have traditionally been treated with hormone replacement therapy (HRT); however, after a trial suggesting an association between HRT and a number of serious adverse events, alternative therapies for VMS are being studied. The purpose of this review is to evaluate the available literature regarding the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) for the alleviation of VMS associated with menopause. Methods PubMed and Ovid/MEDLINE keyword searches were conducted. Literature was reviewed for inclusion if it included any SSRI or SNRI for menopausal symptoms published prior to August 31, 2014. Results Seven studies were included in this review article. No articles were found directly comparing HRT to either SSRIs or SNRIs. Multiple agents within these two classes have been studied for VMS in menopausal and postmenopausal women. Discussion Vasomotor symptoms related to the perimenopausal and postmenopausal period can lead to significant physical distress, often requiring medical intervention. Traditional therapies for VMS of menopause have been dominated by the use of HRT. There are conflicting data regarding the use of SSRIs and SNRIs for patients with vasomotor symptoms related to menopause, and these agents may not be ideal for all patients. These agents may be considered as an alternative in patients who have a contraindication or are concerned about using hormonal therapies.