Does Fluoxetine Help with Menopause? (+ 5 other drugs)

This article explores whether fluoxetine can help with menopause symptoms. It discusses the limited evidence for fluoxetine’s effectiveness in managing menopausal conditions such as anxiety, mood swings, depression, body weight, and hot flashes.

The article also mentions potential side effects and risks of fluoxetine use during menopause. Alternative strategies and medications are also discussed.

Does fluoxetine help with menopause?

Fluoxetine is not approved for treating post-menopausal symptoms, as it is primarily prescribed for the treatment of depression and anxiety disorders. Some studies, however, suggest that it may also be beneficial in managing certain menopausal conditions.

Post-menopausal symptoms commonly include hot flashes, mood changes, and sleep disturbances. The evidence for fluoxetine’s effectiveness in alleviating these symptoms is limited and mixed. However, it can be concluded that it is effective in managing anxiety, mood swings, and depression associated with menopause, but not in managing body weight or hot flashes.

What does research say?

One study investigated the impact of administering fluoxetine and tianeptine on emotional health and eating disorders in menopausal women. It found that after 6 months, fluoxetine was more effective in reducing anxiety and depression, but did not lead to a decrease in body mass index or obesity [1].

Another investigation studied the effectiveness of fluoxetine and melatonin in treating emotional disorders in overweight postmenopausal women. It was found that both treatments are effective, as they both substantially improved anxiety and depression levels [2].

However, the group receiving combined fluoxetine and melatonin treatment showed a reduction in body mass index, whereas the group receiving only fluoxetine did not show a significant reduction in BMI. This suggests that the combined administration of fluoxetine and melatonin may be useful in managing mood, sleep, and appetite disorders in postmenopausal women [2].

Moreover, several controlled trials found that taking fluoxetine plus oral hormone replacement therapy (HRT) was associated with the largest improvement in depressive symptoms compared to placebos. However, these findings did not apply to post-menopausal women without depression [3]. 

Regarding hot flash management, a study showed that fluoxetine resulted in a modest improvement in hot flashes, with a decrease of 50% in hot flash scores compared to a 36% reduction with a placebo [4]. 

In contrast, a study comparing citalopram and fluoxetine with a placebo found that both medications had little effect on hot flashes, and therefore, cannot be recommended for the treatment of menopausal symptoms related to vasomotor complaints [5] 

Moreover, in multiple studies compared the efficiencies of drugs in managing hot flashes in post-menopausal women, gabapentin, citalopram, and black cohosh were found to be more effective than fluoxetine [5] [6] [7].

What are the side effects of using fluoxetine in menopause?

While fluoxetine may be effective in treating certain menopausal symptoms, it is very important to know the possible adverse effects and risks associated with its administration. Here are some possible side effects and risks [8]:

• Gastrointestinal issues: fluoxetine may cause gastrointestinal problems such as nausea, diarrhea, heartburn, or constipation. These side effects are usually mild and temporary but can be bothersome for some individuals, especially menopausal women [8]. 
• Libido: some menopausal women may experience libido as a side effect of fluoxetine use. They may notice a decrease in sexual desire and orgasms may become harder to achieve [8].
• Sleep disturbances: fluoxetine can affect sleep patterns and cause insomnia or excessive sleepiness in some individuals. This side effect can be intensified in postmenopausal women. It is recommended to take fluoxetine in the morning to minimize the risk of sleep disturbances [8]
• Weight changes: weight gain or weight loss can occur as a side effect of fluoxetine use. While the exact mechanism is not fully understood, it is important to monitor any significant changes in weight during treatment [8].
• Bone health: some studies suggest that long-term use of SSRIs like fluoxetine may increase the risk of bone fractures due to decreased bone density. This risk should be considered especially for menopausal women who are already at an increased risk for osteoporosis [9].

What to do if fluoxetine does not help with menopausal symptoms?

When fluoxetine is not effective in helping with post-menopausal symptoms, several alternative strategies can be explored. Here are some management strategies that can be considered:

Hormone Replacement Therapy (HRT)

HRT works by restoring the decreased estrogen levels in menopause. That restoration of estrogen helps in the treatment of symptoms like hot flashes, mood disturbances, and vaginal dryness. However, it is essential to consult with a doctor before administering HRT, as it comes with its own side effects.

Lifestyle modifications

Aiming for a healthier lifestyle can greatly improve menopausal symptoms. It is highly recommended for menopausal women to exercise regularly, make healthier food choices, and practice stress-reduction techniques like yoga or meditation. This can help manage symptoms like mood swings, weight gain, and sleeping issues.

Alternative therapies

Alternative therapies like acupuncture, and herbal supplements like black cohosh have shown satisfactory results in treating menopausal symptoms. In addition, relaxation techniques like deep breathing exercises can also be effective.

Cognitive-behavioral therapy (CBT)

CBT is a talking treatment that involves discussing your current negative thinking patterns and behaviors. It aims to help you deal with these negative thoughts more positively. This may aid in managing mood changes, anxiety, and depression in menopause.

Non-hormonal medications

Several non-hormonal medications may be prescribed to manage specific menopausal symptoms. However, you must discuss your preferred treatment plan with a doctor first.

Remember, discussing your concerns with a healthcare provider is crucial to identify the most suitable management strategies for your specific case. They will study and analyze your current health status and medical history to choose the best treatment for you.

What other drugs can help manage post-menopausal symptoms?

Various other drugs can be used to help with menopause and its undesirable manifestations, these medications include:

Selective Serotonin Reuptake Inhibitors (SSRIs)

Some SSRIs have been commonly prescribed and used for reducing manifestations associated with menopause, they include:

• Paroxetine: Typically taken at a dose of 10-40 mg daily to reduce hot flashes, manage depression and anxiety, and improve sleep quality in menopausal women.
• Escitalopram: The usual starting dose is 10 mg daily, which can be adjusted based on individual response.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):

Some of the SNRIs that showed effectiveness in helping with post-menopausal symptoms include:

• Venlafaxine: Typically prescribed at a dose of 37.5-150 mg daily for managing hot flashes, it is also effective in treating mood disturbances in menopause.
• Gabapentin: Often used at a dose of 300-900 mg daily for reducing hot flashes.

Clonidine

Clonidine works by stimulating certain receptors in the brain that regulate blood pressure and body temperature. It showed effectiveness in reducing the frequency and severity of hot flashes in women in menopause.

It is primarily used in the form of a patch, delivering a continuous dose of 0.1 mg over a week. Oral tablets are also available, typically prescribed at a starting dose of 0.1 mg twice daily.

Conclusion

In conclusion, while fluoxetine is not approved for managing post-menopausal symptoms, some studies suggest it may help with certain aspects of menopause. It appears to be effective in managing anxiety, mood swings, and depression associated with menopause, but not body weight or hot flashes.

It is important to note that fluoxetine may have certain side effects and risks, including gastrointestinal issues, sexual dysfunction, sleep disturbances, and potential effects on bone health. If fluoxetine is not effective in managing post-menopausal symptoms, alternative strategies can be explored.

These strategies include taking hormone replacement therapy, making lifestyle adjustments, trying cognitive-behavioral therapy, and administering other non-hormonal drugs. To make the most suitable decision, it is crucial to consult with your doctor. They will determine the best treatment plan for your specific case.

Other drugs that can help manage post-menopausal symptoms include gabapentin, escitalopram, paroxetine, clonidine, venlafaxine, and black cohosh, which may be more effective for managing menopausal symptoms, especially hot flashes and sleep disturbances.

References