Gabapentin vs. low-dose transdermal estradiol for treating post-menopausal women with moderate to very severe hot flushes

Abstract

Background. Gabapentin (GPT), a widely used drug in neurology, has been proposed as a non-hormonal option for the management of hot flushes in menopausal women with contraindications for estrogen therapy.

Objective. To compare GPT versus low-dose transdermal estradiol (E₂) for treating post-menopausal women with moderate to very severe hot flushes.

Methods. A total of 45 post-menopausal women with moderate to very severe hot flushes were prospectively and single-blinded randomised to receive oral GPT 600 mg/night or transdermal 25 μg/day E₂ per week. Hot flush intensity and frequency were assessed with the Menopause Rating Scale and a numeric scale respectively at baseline and at 1, 4 and 8 weeks. Side effects were also assessed.

Results. Hot flush intensity and frequency significantly decreased for both groups at 1, 4 and 8 weeks of treatment as compared to baseline; however, this decrease was statistically more evident for the E₂ group. Although the percentage of hot flush intensity and frequency reduction at the end of the treatment was higher for E2, this was not statistically significant (68.2% vs. 60.6% for intensity and 70.1% vs. 58.9% for frequency, respectively, p > 0.05, NS). Encountered side effects included: drowsiness, dizziness, fatigue (GPT group) and mastodynia, vaginal spotting and a local allergic reaction (E₂ group). Compliance to treatment was 95.6% (GPT group) as compared to 90.9% for the E₂ group.

Conclusion. Despite statistical significant differences, from a clinical point of view oral GPT 600 mg was as effective as low-dose transdermal E₂ in controlling moderate to severe hot flushes in post-menopausal women, and should be recommended as an alternative option in those with contraindications to estrogen therapy. More research is warranted in this regard.

Keywords:

• Hot flushes
• post-menopause
• gabapentin
• transdermal estradiol

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.