An Alternative to Estrogen for Hot Flashes

Estrogen has been under so much attack for long-term safety issues that women and their doctors are reluctant to use it to treat menopausal symptoms. But there’s no denying that it works very well, and is effective even if given for only a short period. Now an alternative may be coming to the rescue – gabapentin.

Gabapentin was approved in 1994 for the treatment of seizures, and is thought to work by its affinity for calcium entry points (channels) to brain cells. Now a double-blind trial has been reported in 60 menopausal women with moderate to severe hot flashes. They were given estrogen, gabapentin, or placebo, for 12 weeks. The women recorded their hot flashes in a diary for 2 weeks before and then during the treatment period. They also noted any depression and other symptoms of menopause.

Gabapentin and estrogen were significantly more effective than placebo in reducing the hot flash ‘scores’ during weeks 2 through 11 of treatment, but there was no difference at week 12. Placebo reduced the scores by 54%, while gabapentin and estrogen, at 71% and 72% effectiveness, respectively, were both about 20% more effective than placebo.

Overall, side effects were the same in both treatment groups, gabapentin had more reports of headache, dizziness, and disorientation; this group of symptoms may occur in as many as 1 in 3 patients on gabapentin. Nevertheless, it seems clear that gabapentin offers an alternative to those women who have distressing symptoms but want to avoid estrogens.