Menopause: Breakthrough treatment or hype?

Why I don’t see a reason to cheer.

Whenever I see a new treatment for Women’s Health, especially the unsexy phases of a woman’s life, like menopause, I want to cheer. But not this time. When I read about the new non-hormonal treatment for menopausal hot flashes, called Brisdelle, it just made me hot.


Because it’s not a new treatment at all. In fact, the active ingredient in this “new” drug is, paroxetine.  Paroxetine, best known in the U.S. as Paxil,  has been around since 1992. It is a drug I’ve prescribed many times for depression, anxiety, especially panic, and even premature ejaculation in men. While there are some problems with side effects like drowsiness, dry mouth, dizziness, and blurred vision to name a few, these are not uncommon in the whole class of drugs called Selective Serotonin Reuptake Inhibitors (SSRIs) like, Prozac, Zoloft, Celexa, Lexapro, etc.
What does present a problem with this new non-hormonal treatment for hot flashes in menopause, at least in my mind is:

  • Brisdelle sounds like a new drug–which it really is not. Look at the cover, under “Brisdelle” you will see “paroxetine”
  • Buying generic paroxetine and taking it at a lower dose (7.5 mg) should be the equivalent.
  • Paroxetine withdrawal tends to be harder for many patients, see this CNN Psychiatrist’s comments about the drug
  • SSRI’s have been associated with loss of bone mineral density. Read this Harvard Mental Health Letter for more info.
  • Paroxetine tends to decrease sex drive, and time to orgasm. See this Mayo Clinic report on causes of low sex drive in women and you will find that Paxil is first on the list of possible offending medications.

So, I hope you see why I felt a hot flash, not menopausal, but just from anger about this so-called new drug for hot flashes. If you have a different opinion, or would like to share your reactions to Brisdelle, Paroxetine or Paxil, I’d love to hear it. They say that misery loves company. I’m not sure what frustration loves.




4 thoughts on “Menopause: Breakthrough treatment or hype?

  1. jeffrey dach md

    In my opinion, the use of a psycho-active drugs such as SSRI anti-depressants for treatment of symptoms caused by menopausal hormone deficiency is an abuse and mistreatment of women belonging in a medical museum as an example of medical iatrogenesis in women.

    Not only is paroxetine, Paxil medically ineffective for treatment of menopausal symptoms (a hormone deficiency state), Paroxetine, Paxil is one of the most addictive of the SSRI drugs, with warnings about severe withdrawal effects.

    The abuse of women by prescribing psychiatric drugs for menopausal symptoms is a cruel form of abuse and mistreatment which should be halted immediately.

    for more

    jeffrey dach md

    1. Elaine Foster

      I agree to an extent. I would like to see medicine pay greater respect to women’s issues and I think this rebrand of paroxetine is a good example of how greed can sometimes trump beneficence in medicine. Thank you for responding. I thought I would hear from more women concerning this issue and it’s nice to know a man with your credentials cares enough to weigh in on it. I wish more M.D.s felt the way you do.

  2. Tricia Gallagher Hempel

    Hey Elaine,
    I love your blog.
    My new gp and I recently had a discussion about doing the opposite — taking me off effexor now that I’m in menopause. She is the first MD to question whether or not I wanted to eventually wean off, which I always did plan to, but none of my doctors suggested it until her. (Been on Paxil and then effexor for 17 years) We are doing it slowly and looking at other lifestyle changes to offset potential problems. Plus, I can increase the dosage if I need to at anytime. But I am wondering where the studies are on the longterm effects of these SSRIs.
    Keep up the great work with the blog — I will check back often!

    1. Elaine Foster

      Hi Tricia,
      I’m glad you are using a slow taper with the Effexor since it rivals Paxil when it comes to discontinuation. Paxil and Effexor (unless you are on the XR version of the latter) have pretty short half lives so they are hard to stop. In any case, I like the fact that you are going to try to see if you can do without. Worst thing that happens is you go back on a different medication, or even the same medication if necessary, but at least you will know you tried. Also, the lifestyle changes you noted will give you the best “fighting chance.” If you are looking for more info on the bone mineral density studies and SSRIs, I added a hyperlink to my post that will take you to the Harvard Newsletter that references the research on this topic. It is worth taking a look at. Thanks for checking out the site!


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