SSRIs for hot flashes: a systematic review and meta-analysis of randomized trials

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; I(2) = 21 %) and severity assessed by various scales (standardized difference in means -0.34; 95 % CI -0.59 to -0.10; I(2) = 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.

Figure 1.

Flow chart of the study.

Figure 2.

Meta-analyses. Panel a: Improvement in hot flash frequency per day. Panel b: Improvement in standardized hot flash scale scores. Panel c: Adverse events.

Figure 2.

Meta-analyses. Panel a: Improvement in hot flash frequency per day. Panel b: Improvement in standardized hot flash scale scores. Panel c: Adverse events.

Figure 3.

SSRI network: Each edge (circle) represents a treatment; connecting lines indicate pairs of treatments that have been directly compared in randomized trials. The numbers on the lines indicate the numbers of trials making that comparison.