Published Nov 11, 2013, EveryDay Health
The millions of menopausal women who are sweating, disrobing and desperately trying to manage their hot flashes by layering clothes, taking herbs and carrying a portable fan now have another alternative. Brisdelle™, the first and only FDA approved non-hormonal option for hot flash relief is now available.
Up until now the only FDA approved products proven to reduce hot flashes have been estrogen-based prescriptions. I am in the camp that most women can safely take estrogen and that the risks are dramatically smaller than many women think. But, having said that, I am also well aware that in spite of the reassurances of menopause experts like myself, the majority of women choose not to take estrogen, or have been advised by their doctors to steer clear. In fact only 7% of women with hot flashes ultimately accept a prescription for estrogen. The rest just tough it out.While that works out for some women, (like the one’s who live in Alaska), other’s who have severe hot flashes though out the day and nights are totally blind sided by just how debilitating hot flashes can be. Many women also are not prepared for how long they last. While the average woman can expect to experience moderate to severe hot flashes for 3- 5 years, in some women they continue forever.
Brisdelle™ is a low dose (7.5 mg) of paroxetine, one of the selective serotonin reuptake inhibitor (SSRI) antidepressants that years ago was serendipitously found to significantly reduce hot flashes in menopausal women. I, like many physicians, have in the past prescribed paroxetine “off label”. There are two reasons why I am glad I can now prescribe a low dose FDA approved version as opposed to generic paroxetine:
- Paroxetine at higher doses is intended for, studied and FDA approved only for the treatment of depression, not hot flashes. Many of my patients have received a prescription and then also had the experience of their insurance company giving them a diagnosis of depression even though they are not depressed. Just hot. I had one patient for whom I prescribed Paxil for hot flash relief (clearly documented on her electronic medical record) who was contacted by her insurance company to see if her “depression” was improving and to offer psychotherapy! Brisdelle 7.5 mg is FDA approved only for treatment of moderate to severe hot flashes as a result of menopause. It cannot, and should not, be prescribed for treatment of depression and therefore is not interpreted as a treatment for depression on your medical record.
- The doses of generic paroxetine available for treatment of depression are higher than needed to relieve hot flashes. With higher dosage, comes a greater risk of side affects. As an example, Paxil and other SSRI’s are associated with an increase in sexual problems and an increase in pounds. The last thing a menopause women needs is a drug that might sabotage her diet or an already waning sex drive. In clinical trials, Brisdelle, with only 7.5 mg of paroxetine, did not demonstrate a decrease in libido or an increase in weight.
Every once in awhile someone will say, my grandmother didn’t take anything for hot flashes, why should I? Well grandma was more likely to be home baking cookies than doing a job that required a good nights sleep and the ability to think clearly. Grandma was unlikely to be starting a second marriage or a new relationship in her 50’s. Grandma likely did not live nearly as long as you will. The average age of menopause is 51, which means most woman will live more than one third of her life post menopause.
So, you now have options, and whether you personally decide to take estrogen, Brisdelle or do yoga to manage your flashes; you owe it to yourself to know what those choices are.