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Venlafaxine for Menopausal Symptoms

Non-hormonal treatment of menopausal symptoms


What is venlafaxine?

Venlafaxine is an antidepressant of the SNRI (serotonin–noradrenaline reuptake inhibitor) class. In the UK it’s licensed to treat depression, generalised anxiety disorder, social anxiety disorder, and panic disorder.


It’s also used off-label to help with hot flushes and night sweats (vasomotor symptoms) when HRT isn’t suitable or preferred.


Menopausal lady using venlafaxine as an alternative to HRT

How can it help?


  • Hot flushes/night sweats: Good trials show venlafaxine reduces episodes by ~40–50% within 8 weeks, with benefits often starting in ~2 weeks. In a large randomised trial, venlafaxine 75 mg/day reduced hot-flush frequency by 1.8 more episodes/day than placebo and gave improvements similar to low-dose oestradiol.


  • Mood and anxiety: Because venlafaxine treats depression and anxiety disorders, many people also notice improvements in mood, anxiety and overall coping, especially if these symptoms are present alongside hot flushes. In a menopause trial, venlafaxine improved the psychosocial (mood-related) quality-of-life domain, and modestly reduced perceived stress—even though most participants did not have clinical depression/anxiety at baseline.


  • If you’re taking tamoxifen: Venlafaxine is often preferred over certain SSRIs because it doesn’t meaningfully block tamoxifen activation.


How does it work?

Falling oestrogen during menopause narrows the brain’s thermoregulatory “comfort zone.” By boosting serotonin and noradrenaline, venlafaxine helps stabilise this system in the hypothalamus, which can reduce flushes and sweats.


Dosing


Your prescriber will tailor this, but a common plan is:

  • Start: 37.5 mg modified/prolonged-release once daily for 1 week.

  • Then: increase to 75 mg once daily.

  • If needed: some may increase gradually (e.g., up to 150 mg/day). Many do well on 75 mg/day. Benefits for flushes usually begin within ~2 weeks and build over 4–8 weeks. Take with food; morning dosing may help if it disturbs sleep.


Side effects


Common (often settle in 1–2 weeks): nausea, dry mouth, headache, sweating, dizziness, insomnia or sleepiness, constipation, sexual side-effects.


Important but less common:

  • Raised blood pressure (dose-related).

  • Low sodium (hyponatraemia): risk is higher in older adults—seek help for confusion, severe headache, cramps.

  • Bleeding risk if combined with aspirin/NSAIDs/warfarin.

  • Mood changes or suicidal thoughts—seek urgent help.

  • Serotonin syndrome with other serotonergic drugs (e.g., MAOIs, linezolid, tramadol, triptans, St John’s wort).


Monitoring


  • Blood pressure/pulse: check before starting, again after 2–4 weeks and after dose changes, then periodically. Control any high BP first.


Interactions & cautions


Tell your clinician if you:

  • Take tamoxifen (venlafaxine is generally a preferred choice versus strong CYP2D6-inhibiting SSRIs like paroxetine/fluoxetine).

  • Use other serotonergic drugs (risk of serotonin syndrome).

  • Have uncontrolled hypertension, heart disease, glaucoma, seizures, bipolar disorder, or kidney/liver problems—dosing or choice may need adjusting.


How long to take it?


There’s no fixed limit. Continue as long as benefits outweigh side-effects, with periodic reviews. Some taper off after symptoms settle; others continue through symptomatic years.


Stopping venlafaxine (important)


Don’t stop suddenly—withdrawal symptoms (dizziness, “electric-shock” feelings, anxiety, sleep problems) can occur. Taper slowly with your prescriber’s advice.


Alternatives if venlafaxine isn’t right for you


  • Other SSRIs/SNRIs (e.g., citalopram, escitalopram—avoid paroxetine/fluoxetine with tamoxifen).


  • Fezolinetant (a non-hormonal NK3-receptor blocker): MHRA-licensed in the UK but currently private-prescription only and requires liver-function monitoring; NICE NHS appraisal is ongoing.


Quick summary


  • Venlafaxine is a non-hormonal tablet that reduces hot flushes/night sweats and can also help mood/anxiety, particularly if these are current problems.


  • Start low (37.5 mg), usually target 75 mg/day; benefits often in ~2 weeks. Monitor blood pressure and watch for low sodium in older adults.



    References

  • NAMS 2023 Position Statement (Nonhormone therapy): dosing range, onset, efficacy vs low-dose oestradiol. The Menopause Society

  • Joffe et al., 2014 (JAMA Internal Medicine): venlafaxine reduced hot flushes by 1.8/day vs placebo; overall ~48% reduction from baseline at 8 weeks. PubMed

  • Caan et al., 2015 (Menopause): venlafaxine improved MENQOL psychosocial (mood-related) scores; modest effect on perceived stress. PMC

  • BMS Consensus (Sept 2024): UK overview of non-hormonal treatments; notes venlafaxine as an option, esp. after breast cancer; cautions re paroxetine/fluoxetine with tamoxifen. British Menopause Society

  • NHS: About/Side effects of venlafaxine: licensed uses (depression/anxiety), onset, side effects, and advice on tapering. nhs.uk+1

  • NICE CKS (Tamoxifen prescribing info): prefer antidepressants with weak CYP2D6 inhibition (e.g., venlafaxine). NICE

  • MHRA safety communication: BP monitoring recommended for venlafaxine.

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