Missed symptoms of menopause

This review examines the available data on the efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) for treating the commonly missed climacteric symptoms of menopause.

Although some women may pass through the menopausal transition phase with few or no symptoms, the majority experience one or more symptoms serious enough to be disruptive to their lives. The most common are vasomotor symptoms (VMS; hot flushes and night sweats), but they are not the only climacteric symptoms that can negatively affect quality of life. The 'missed symptoms' of menopause -- symptoms with high prevalence and an impact on quality of life that nonetheless receive less attention than do VMS -- include mood changes, sleep disturbances and somatic complaints. These symptoms are reported by approximately half of menopausal women, with numbers varying by region and ethnic background. As with VMS, the effects of declining oestrogen levels on serotonin/noradrenaline pathways could play a role in their development.

Results from pilot studies of several SSRIs and SNRIs suggest that they may improve menopausal mood and sleep symptoms, but few studies have demonstrated significant improvement compared with placebo. One SNRI (venlafaxine) improved menopausal mood symptoms and two SSRIs (citalopram and paroxetine) improved sleep, each in a single placebo-controlled trial of women with VMS. Additional placebo-controlled trials are needed to determine whether SSRIs or SNRIs are effective treatment options for women who cannot or choose not to use hormone therapy.