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SSRIs for Hot Flashes: A Systematic Review and Meta-Analysis of Randomized Trials

Journal of General Internal Medicine volume 29, pages 204–213 (2014)Cite this article

ABSTRACT

Background

Hot flashes are the most commonly reported vasomotor symptom during the peri- and early post-menopausal period.

Objectives

To systematically review, appraise and summarize the evidence of the impact of different SSRIs on peri-menopausal hot flashes in healthy women in randomized, controlled trials.

Methods

A comprehensive literature search was conducted of MEDLINE™, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and Scopus through March 2013. Two independent reviewers selected studies and extracted data. Random effects meta-analysis was used to pool outcomes across studies, and Bayesian mixed treatment methods were used to rank SSRIs in terms of effectiveness.

Results

We included a total of 11 randomized controlled trials with good methodological quality enrolling 2,069 menopausal and post-menopausal women (follow-up 1–9 months, mean age 36–76 years, mean time since menopause 2.3–6.6 years). Compared with placebo, SSRIs were associated with a statistically significant decrease in hot flash frequency (difference in means −0.93; 95 % CI −1.46 to −0.37; I2 = 21 %) and severity assessed by various scales (standardized difference in means −0.34; 95 % CI −0.59 to −0.10; I2 = 47 %). Adverse events did not differ from placebo. Mixed treatment comparison analysis demonstrated the superiority of escitalopram compared to other SSRIs in terms of efficacy.

Conclusion

SSRI use is associated with modest improvement in the severity and frequency of hot flashes but can also be associated with the typical profile of SSRI adverse effects.

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Acknowledgement

Source of Funding

None

Disclosures

This study was made possible by support from the Center for the Science of Healthcare Delivery, Mayo Clinic, and CTSA grant UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Affiliations

  1. National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Taghreed Shams MBBS, FRCSC, Farida Habib PhD, Abeer Alshahrani MBBS, Badria AlNouh MBBS & Mazen Ferwana MD

  2. Department of Obstetrics and Gynecology, King Saud Bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Saudi Arabia

    Taghreed Shams MBBS, FRCSC & Badria AlNouh MBBS

  3. Department of Internal Medicine, University of Missouri, Columbia, MO, USA

    Belal Firwana MD

  4. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA

    Belal Firwana MD & Mohammad Hassan Murad MD

  5. Department of Nursing, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Farida Habib PhD

  6. Department of Family Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

    Abeer Alshahrani MBBS & Mazen Ferwana MD

  7. Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA

    Mohammad Hassan Murad MD

Authors
  1. Taghreed Shams MBBS, FRCSC
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  2. Belal Firwana MD
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Corresponding author

Correspondence to Taghreed Shams MBBS, FRCSC.

Additional information

Taghreed Shams and Belal Firwana contributed equally to this work.

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Shams, T., Firwana, B., Habib, F. et al. SSRIs for Hot Flashes: A Systematic Review and Meta-Analysis of Randomized Trials. J GEN INTERN MED 29, 204–213 (2014). https://doi.org/10.1007/s11606-013-2535-9

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  • DOI: https://doi.org/10.1007/s11606-013-2535-9

KEY WORDS

  • SSRI
  • hot flashes
  • menopause