Level 1: Likely reliable evidence

Hot flushes are one of the more bothersome symptoms of menopause. Traditionally treated with estrogens, alternative medications have been sought to avoid the risks of hormone replacement therapy. A recent randomized trial evaluated the effectiveness of escitalopram for reducing the frequency and severity of hot-flush symptoms (JAMA. 2011;305:267-274). Women with menopausal symptoms (N=205) were randomized to escitalopram (Lexapro) 10-20 mg/day vs. placebo for eight weeks and maintained a hot-flush diary. Escitalopram reduced daily hot-flush frequency and severity. Comparing escitalopram vs. placebo, daily frequency of hot-flush episodes decreased by 4.6 vs. 3.2 (P <0.001), with at least 50% reduction in frequency in 55% vs. 36% of women (P=0.009, NNT 6). Mean hot-flush severity scores were also reduced with escitalopram (P <0.001). The benefits did not persist after the end of treatment: three weeks after discontinuation, women from the escitalopram group reported an increase in the frequency of hot flushes (mean 1.59 more hot flushes per day) compared with the placebo group.