• To help reduce hot flushes, women should be encouraged to take regular exercise, reduce stress and wear lighter clothing. Any trigger factors should be avoided.

• Antidepressants are unlicensed for the management of hot flushes but may be considered for women who have contra-indications to or concerns about hormone replacement therapy (HRT). Limited evidence from a recent meta-analysis suggests that venlafaxine, paroxetine, citalopram or fluoxetine are effective in reducing the frequency and severity of menopausal hot flushes.

•  Relief from hot flushes with selective serotonin re-uptake inhibitors (SSRIs) and venlafaxine is typically achieved at lower doses and more rapidly compared with the management of depression. A short-term trial of 1-2 weeks may be adequate to assess the effect of an SSRI (3 weeks for fluoxetine) or venlafaxine for hot flushes. A low dosage of antidepressant should be used initially, which should be titrated according to effect. The most appropriate dosage and duration of treatment has not been established.

• The Royal College of Obstetricians and Gynaecologists suggests that the most convincing data available are for venlafaxine at a dose of 37.5mg twice daily. Further trials are needed to confirm efficacy and long-term safety.

• Studies have also been conducted using moclobemide, sertraline, duloxetine and escitalopram which have produced variable results.

• Most of these studies have been short-term, and the long-term efficacy of non-hormonal treatment for hot flushes is not known. As data are limited, it has been suggested that their use should be restricted to highly symptomatic women who cannot take oestrogen.

 
• This Medicines Q&A has not addressed drug interactions. However, it has recently been suggested that strong CYP2D6 inhibiting SSRIs (e.g. paroxetine, fluoxetine) should be avoided in women taking tamoxifen.

 
• Clinicians should continuously review efficacy of treatment and assess whether an alternative treatment is necessary.