Document Type : Original Article
Authors
Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Objective: Various non‑hormonal agents have been used for the treatment of hot flashes
in women with menopause. Some studies have reported that gabapentin appears to be an
effective and well‑tolerated treatment modality. The aim of this study was to evaluate whether
the treatment with gabapentin is effective in reducing hot flash frequency and severity and
also to compare gabapentin 100 mg/day, 300 mg/day and conjugated estrogen in this regards.
Methods: In this comparative clinical trial, 100 post‑menopausal women attending outpatient
clinics of Isfahan University hospitals were included from April 2008 to February 2009.
Participants randomly received gabapentin 300 mg/day, gabapentin 100 mg/day, or conjugated
estrogen 0.625 mg/day for 12 weeks. Frequency and severity of hot flashes and adverse
effects were compared among the three groups.
Findings: From all, 16 participants dropped out. There were no significant differences among
the groups before intervention in terms of age, body mass index and baseline hot flash
frequency and severity. Hot flash diaries were used to record the frequency and severity of
hot flashes. After the treatment period, there was a significant decrease in both severity and
frequency of hot flashes in all three groups. Post‑hoc analyses showed that the frequency and
severity of hot flashes were significantly lower in those who received gabapentin 300 mg/day
or estrogen 0.625 mg/day compared to those who received gabapentin 100 mg/day. There
was not statistically significant difference between those who received gabapentin 300 mg/day
and those who received estrogen. Very few adverse effects, mostly gastrointestinal discomfort
were observed in both gabapentin groups (8%).
Conclusion: Gabapentin 300 mg/day could be useful to relieve hot flashes in women
for whom hormone therapy is not suitable or when hot flashes do not respond to other
therapies. Further researches are needed to determine the efficacy of gabapentin use for
longer periods or at higher doses.
Keywords
- Shifren Jan L, Schiff I. Menopause. In: Berek JS, Berek DL,
Hengst TC. editors. Berek and Novakxs Gynecology. 15th ed.
New York: Lippincott Williams and Wilkins; 2012. p. 1234.
2. Schiff I, Regestein Q, Tulchinsky D, Ryan KJ. Effects of
estrogens on sleep and psychological state of hypogonadal
women. JAMA 1979;242:2405‑4.
3. Siddle N, Sarrel P, Whitehead M. The effect of hysterectomy
on the age at ovarian failure: Identification of a subgroup of
women with premature loss of ovarian function and literature
review. Fertil Steril 1987;47:94‑100.
4. Freedman RR, Subramanian M. Effects of symptomatic status
and the menstrual cycle on hot flash‑related thermoregulatory
parameters. Menopause 2005;12:156‑9.
5. Kronenberg F, Barnard RM. Modulation of menopausal hot
flashes by ambient temperature. J of Therm Biol 1992;17:43‑9.
6. Bachmann GA, Schaefers M, Uddin A, Utian WH. Lowest
effective transdermal 17beta‑estradiol dose for relief of hot
flushes in postmenopausal women: Arandomized controlled
trial. Obstet Gynecol 2007;110:771‑9.
7. Notelovitz M, Lenihan JP, McDermott M, Kerber IJ,
Nanavati N, Arce J. Initial 17beta‑estradiol dose for treating
vasomotor symptoms. Obstet Gynecol 2000;95:726‑31.
8. Sturdee DW. The menopausal hot flush: Anything new?
Maturitas 2008;60:42‑9.
9. National Institutes of Health. National Institutes of Health
State‑of‑the‑Science Conference statement: Management
of menopause‑related symptoms. Ann Intern Med
2005;142:1003‑13.
10. Guttuso T Jr, Kurlan R, McDermott MP, Kieburtz K.
Gabapentin's effects on hot flashes in postmenopausal
women: A randomized controlled trial. Obstet Gynecol
2003;101:337‑45.
11. Brown JN, Wright BR. Use of gabapentin in patients
experiencing hot flashes. Pharmacotherapy 2009;29:74‑81.
12. Stearns V. Clinical update: New treatments for hot flushes.
Lancet 2007;369:2062‑4.
13. Nelson HD, Vesco KK, Haney E, Fu R, Nedrow A, Miller J,
et al. Nonhormonal therapies for menopausal hot flashes:
Systematic review and meta‑analysis. JAMA 2006;295:2057‑71.
14. Guttuso TJ Jr. Gabapentin’s effects on hot flashes and
hypothermia. Neurology 2000;54:2161‑3. - 15. Collaborative Group on Hormonal factors in Breast cancer.
Breast cancer and hormone replacement therapy: Collaborative
reanalysis of data from 51 epidemiological studies of 52,705
women with breast cancer and 108,411 women without breast
cancer. Lancet 1997;350:1047‑59.
16. Aguirre W, Chedraui P, Mendoza J, Ruilova I. Gabapentin vs.
low‑dose transdermal estradiol for treating post‑menopausal
women with moderate to very severe hot flushes. Gynecol
Endocrinol 2010;26:333‑7.
17. Butt DA, Lock M, Lewis JE, Ross S, Moineddin R. Gabapentin
for the treatment of menopausal hot flashes: A randomized
controlled trial. Menopause 2008;15:310‑8.
18. Loprinzi CL, Kugler JW, Barton DL, Dueck AC, Tschetter LK,
Nelimark RA, et al. Phase III trial of gabapentin alone or in
conjunction with an antidepressant in the management of
hot flashes in women who have inadequate control with
an antidepressant alone: NCCTG N03C5. J Clin Oncol
2007;25:308‑12.
19. Reddy SY, Warner H, Guttuso T Jr, Messing S, DiGrazio W,
Thornburg L, et al. Gabapentin, estrogen, and placebo for
treating hot flushes: A randomized controlled trial. Obstet
Gynecol 2006;108:41‑8.
20. Pandya KJ, Morrow GR, Roscoe JA, Zhao H, Hickok JT,
Pajon E, et al. Gabapentin for hot flashes in 420 women with
breast cancer: Arandomised double‑blind placebo‑controlled
trial. Lancet 2005;366:818‑24.
21. Albertazzi P, Bottazzi M, Purdie DW. Gabapentin for the
management of hot flushes: A case series. Menopause
2003;10:214‑7.
22. Bunyarataveij N, Songpatanaslip T. Application of Gabapentin
in Thia women with menopausal syndrome. J Med Assoc Thia
2005;88:521‑3.
23. Toulis KA, Tzellos T, Kouvelas D, Goulis DG. Gabapentin
for the treatment of hot flashes in women with natural or
tamoxifen‑induced menopause: A systematic review and
meta‑analysis. Clin Ther 2009;31:221‑35.
24. Hayes LP, Carroll DG, Kelley KW. Use of gabapentin for the
management of natural or surgical menopausal hot flashes.
Ann Pharmacother 2011;45:388‑94.
)