Efficacy of Low-Dose Paroxetine for the Treatment of Hot Flushes in Surgical and Physiological Postmenopausal Women: Systematic Review and Meta-Analysis of Randomized Trials

Abstract

Background and Objectives: Hot flushes and sleep disturbances are the most common vasomotor symptoms (VMS) reported by postmenopausal women. Hormonal treatment is to date referred to as the gold standard approach but not suitable for all the patients. Alternative treatments are needed in case of a contraindication to menopausal hormone therapy (MHT), adverse side effects, and poor compliance. Paroxetine salt is the only nonhormonal medication approved by the US Food and Drug Administration for the management of VMS. Nonetheless, few trials with low consensus are available about this topic. In this review, we aimed to evaluate the efficacy of low-dose paroxetine therapy in the treatment of vasomotor hot flushes and night sleep disturbances in postmenopausal women. Materials and Methods: We performed an electronic search from the beginning of all databases to July 2019. All results were then limited to a randomized trial. Restrictions for language or geographic location were not utilized. Inclusion criteria were randomized clinical trials of physiological or surgical postmenopausal women experiencing hot flushes and sleep disturbances who were randomized to either low-dose paroxetine or placebo (i.e., formulations without active ingredients). The primary outcome evaluated was the mean weekly reduction of hot flushes. Results: Five randomized clinical trials, including 1482 postmenopausal women, were analyzed. Significant heterogeneity (I2 = 90%) between studies was noted. Hot flushes episodes were significantly reduced in the treatment arm compared to placebo (mean difference (MD) −7.97 [−10.51, −5.92] episodes/week). Results on the improvement on sleep were limited by being reported in only two studies; however, no significant reduction of night-time awakenings was observed (MD, −0.40 awakenings/night [−1.38, 0.58 CI]). Conclusions: Low-dose paroxetine is an effective treatment for vasomotor menopause symptoms, including hot flushes.

New needs for menopausal women during COVID-19 pandemic. A physician-based investigation

“…Physicians are now requested to give greater consideration to mood alterations and to become more familiar with the manage- ment of these increasingly frequent yet often neglected disturbances; here, remedies also capable of re-establishing psychological equilibrium could be more useful. Therapeutical choices should now be directed mainly to pharmacological (30) or non-pharmacological (31-33) remedies capable not only to treat vasomotor symptoms but also to concomitantly improve mood.…”

Prevention and treatment of cystitis during menopause: efficacy of a nutraceutical containing D-mannose, inulin, cranberry, bearberry, Olea europaea, Orthosiphon and Lactobacillus acidophilus

“…Moreover, this condition severely impacts on daily life in several activities such as social and working, lowering the quality of life [ 38 ]. UTIs are also associated with mood changes and anxiety and depression could be experienced by the patients [ 2 , 39 , 40 ]. In older women affected by UTIs, the quality of life could be seriously impaired, especially if urinary incontinence is associated.…”

Black cohosh associated mania in a patient with unipolar depression

“…9,11,12 Escitalopram, citalopram, paroxetine and venlafaxine were found to reduce hot flushes on non-depressed menopausal women as non-hormonal therapy. 13–16 The activity of black cohosh on serotonergic receptors may be the key factor on alleviating somatic symptoms of menopause and menstruation as well as its antidepressant and anxiolytic effects.…”