Estrogen is by far the most effective treatment for hot flushes and night sweats. Clonidine, some antidepressants, and gabapentin (Neurontin) are prescription medications that have been shown in clinical studies to have some effectiveness for hot flushes and night sweats. For women that are not candidates for hormone replacement therapy, cannot tolerate the side effects of HRT, or are unwilling to use these estrogen compounds these medications may be beneficial.
Clonidine is an anti-hypertensive that has been shown to reduce hot flashes and night sweats as well as lower blood pressure. Clonidine is available as a pill or a patch. The pill is fast acting and tends to have more side effects. Because it is designed to lower blood pressure, it may cause side effects in women with normal blood pressure. These include dizziness, headaches, and nausea. The patch has a slower release and tends to have less side effects. Of the non-hormone medications, this is probably the most effective for relieving the symptoms of menopause.
Some of the antidepressant medications also can reduce hot flushes and night sweats. Some, but not all of the SSRI class of medications are helpful for the symptoms of menopause as are some of the other newer antidepressants. Medications in this class that have data for menopausal symptom relief include Celexa, Lexapro, Effexor, and Paxil. Interestingly, Zoloft has been studied and does not help decrease menopause symptoms. The data shows good short term reduction of hot flashes and night sweats with these medications. The long term data seems to show a decrease in effectiveness over time.
Gabapentin, also known as Neurontin, does have some promising data that shows decreased hot flashes and night sweats in menopausal women. The FDA recently denied approval of a long acting form of gabapentin for the indication of menopausal symptom relief. There is a short acting gabapentin that is on the market for other indications that can be used for menopausal symptoms. This needs to be taken three times per day and has the potential for significant side effects.
Estrogen in the form of HRT is far and away the best medication for the symptoms of menopause. These other medications are all available by prescription and FDA approved for other uses. Taking these medications for menopausal symptoms is an “of label use’. This does not mean it is inappropriate or unsafe to use them for hot flashes and night sweats, it does mean that they are not FDA approved for this use. This is the kind of thing that deserves a conversation with your doctor to discuss the risks and possible benefits and decide if it is worthwhile for your unique circumstance.