Hot Flashes: 2 Drugs Have No Effect on Sexual Function

Larry Hand

July 29, 2014

Neither low-dose oral estradiol nor low-dose venlafaxine affected overall sexual function among nondepressed midlife women experiencing bothersome hot flashes during an 8-week randomized controlled trial, according to an article published in the August issue of Obstetrics & Gynecology.

Susan D. Reed, MD, MPH, from the Department of Obstetrics and Gynecology and Epidemiology at the University of Washington School of Medicine, Seattle, and colleagues conducted the study at 5 Menopause Strategies: Finding Lasting Answers for Symptoms and Health network sites in Boston, Massachusetts; Philadelphia, Pennsylvania; and Seattle.

The study included 335 peri- or postmenopausal women aged 40 to 62 years who had at least 14 bothersome or severe hot flashes or night sweats per week for 2 weeks. Researchers randomly assigned the women to receive estradiol (n = 95), venlafaxine (n = 96), or placebo (n = 144) and measured sexual function at baseline, 4 weeks, and 8 weeks.

Of the 335 women, 175 reported sexual activity with male partners, 5 reported sexual activity with female partners, and 105 reported self-stimulation (not mutually exclusive). Among married women or women reporting an intimate relationship, the average duration of relationship was 24 years.

Of all the women, 230 were available for analysis, using the Female Sexual Function Index, from baseline to 8 weeks.

Composite index and sexually related distress did not change from baseline among all 3 trial groups overall. However, for subcomponents, women who experienced small changes included women in the estradiol group, for improvement in desire compared with placebo, and women in the venlafaxine group, for worsened orgasm and improvement in penetration pain compared with placebo (all P = .04). Women in the venlafaxine group reported the greatest improvement in vaginal dryness compared with placebo (P = .006).

"Our findings of diminished pain and dryness with venlafaxine were not anticipated, although there is evidence of biologic plausibility for both," the researchers write. "[I]ncreased serotonin may up- or downregulate serotonin receptors...thus modulating pain, arteriole vasodilation, vasoconstriction, or a combination of these mechanisms."

The researchers conclude that "[t]hese findings are important because the use of serotoninergic agents for hot flushes is likely to increase, because a low-dose formulation of paroxetine was recently approved by the U.S. Food and Drug Administration, representing the first nonhormonal agent indicated for the treatment of vasomotor symptoms."

Reassuring

"It is reassuring that sexual function did not change with venlafaxine vs estradiol," Mary L. Rosser, MD, PhD, assistant professor of obstetrics and gynecology at Albert Einstein College of Medicine and a clinician at Montefiore Medical Center, New York City, told Medscape Medical News. "As pointed out, the effect of selective norepinephrine reuptake inhibitors on sexual function appears to be dose-related."

She continued, "This is what I have observed in the office. A reduction in hot flashes and night sweats will improve sleep and overall quality of life. This is a terrific study, and hopefully these patients will continue to be followed over a longer period of time. I would love to see change in parameters at 3, 6, 12 months."

She added, "I spend the better part of my day discussing sexual function with perimenopausal and postmenopausal women. Sexuality in this population is poorly understood, and this is an area of medicine that has received insufficient study and attention. Additionally, there are a dearth of treatment options for menopausal symptoms, such as vasomotor symptoms. I have started to use paroxetine, but [have] no long-term information to share yet. I believe that there will be an increased use of this agent as clinicians and patients become aware of its new indication."

This research was supported by the National Institute of Aging, Eunice Kennedy Shriver National Institute of Child Health and Development, the National Center for Complementary and Alternative Medicine, and the Office of Research and Women's Health. One coauthor has reported receiving research support from Cephalon/Teva and serving as a consultant to Noven; another coauthor has reported receiving research support from Bristol-Myers Squibb, Cephalon, and Sunovian Pharmaceuticals and serving as a consultant to Noven and PamLab. The other authors and Dr. Rosser have disclosed no relevant financial relationships.

Obstet Gynecol. 2014;124:233-240. Full text

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