Estrogen therapy is a gold standard treatment for hot flashes and night sweats in women but some women are unable or unwilling due to side effects associated with estrogen therapy. Side effects includes headaches, nausea, vaginal discharge, vaginal spotting, painful menstruation, fluid retention, swelling of ankles and legs, abdominal cramps, bloatedness, weight gain, breast tenderness, darkening of skin especially on face, increased risk of growth of preexisting uterine fibroids and worsening or endometriosis and many other side effects. For this kind of patients, a serotonin-norepinephrine reuptake inhibitor Venlafaxine hydrochloride is used as a nonhormonal mode of treatment. There is a clinical impression among doctors that serotonin-norepinephrine reuptake inhibitors are less effective than Estrogen for the treatment of vasomotor symptoms in women.

Finding of a randomized clinical trial has been published in JAMA Internal medicine for comparison between estrogen and venlafaxine therapy for treatment of vasomotor symptoms in perimenopausal and postmenopausal women. In this research  perimenopausal and postmenopausal women were given a low dose of oral 17 beta-estradiol (0.5 mg/day) and a low dose of venlafaxine hydrochloride extended-release (75 mg/day) was given to randomized groups of women separately.

Findings of clinical trials were that there was decreased frequency of vasomotor symptoms (VMS) in both groups i.e women who received estrogen therapy and women who received venlafaxine therapy. Efficacy of estrogen therapy was found to be more than that of venlafaxine but difference is small and of uncertain clinical significance.

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