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Serotonin and Hot Flashes

Updated: Jun 14

Hot flashes are one of the most frequently reported symptoms of perimenopause and menopause. Vasomotor symptoms, aka hot flashes and night sweats, occur in more than 75% of North American women during the transition from perimenopause into menopause, and almost all women with induced menopause or premature menopause. Recent research demonstrates that vasomotor symptoms may last anywhere from 6 months to 14 years with an average duration at 7.4 years.


Woman smiling at camera in a bright room

Hot flashes and night sweats are mostly caused by the hormonal changes of menopause, but can also be affected by lifestyle and medications. Diminished levels of estrogen and progesterone have a direct effect on the hypothalamus, the part of the brain responsible for controlling appetite, sleep cycles, sex hormones and body temperature. The drop in hormones confuses the hypothalamus, also referred to as the body’s thermostat, and makes it read “too hot.” The brain responds to this report by telling the heart, blood vessels and nervous system: “Get rid of the heat!” The message is transmitted almost instantly by the nervous system’s chemical messenger, epinephrine, and additional compounds: norepinephrine, prostaglandins and serotonin. The heart pumps faster, the blood vessels in the skin dilate to circulate more blood to radiate off the heat and the sweat glands release sweat to cool the body.


This heat-releasing mechanism is also how the body keeps from overheating in the summer but when the process is triggered instead by a drop in hormones, the brain’s confused response can make women very uncomfortable. Sometimes giving women an appropriate dose of bioidentical estradiol and progesterone can alleviate hot flashes. However, if hormones, especially estrogen, are not an option, there may be other ways of managing these uncomfortable symptoms.


In 2014, the SSRI “Brisdelle” was approved by the FDA for management of hot flashes. In clinical trials, Brisdelle performed better than placebo, reducing the frequency of hot flashes by 57% to 59% in women who had been reporting at least seven hot flashes per day. The dosage studied was 7.5 milligrams, a dose significantly lower than the typical 30 to 40 milligrams used to treat depression. However, the control group in the study (that is, women who received a placebo) also reported a reduction in the frequency of hot flashes: these women reported a reduction of between 40% and 48%. Women experiencing fewer than seven hot flashes per day were not included in this study, raising the question as to whether Brisdelle would be helpful in milder cases.


The use of SSRIs for hot flash relief is interesting in that it illustrates an association between neurotransmitters and vasomotor symptoms. Achieving neurotransmitter balance can be an effective tool in managing many symptoms, including hot flashes and night sweats. Assessing hormone and neurotransmitter imbalances may be helpful to swiftly developing a successful treatment approach and to restoring quality of life.


References:

Avis, PhD et al. Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. Jama Intern Med. Feb 16, 2015 (Epub ahead of print).


WebMD: FDA approves the first non-hormonal treatment for hot flashes associated with menopause. https://www.webmd.com/menopause/news/20130701/health-highlights-july-1-2013 Accessibility verified 4/11/20.


The North American Menopause Society. http://www.menopause.org/for-women/sexual-health-menopause-online/causes-of-sexual-problems/hot-flashes. Accessibility verified 4/11/2020.

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