Wellbutrin menopause: Pilot evaluation of bupropion for the treatment of hot flashes

25.10.202123.07.2023 by alexxlab

Pilot evaluation of bupropion for the treatment of hot flashes

. 2006 Jun;9(3):631-7.

doi: 10.1089/jpm.2006.9.631.

Domingo G Pérez¹, Charles L Loprinzi, Jeff Sloan, Paul Novotny, Debra Barton, Lisa Carpenter, Deanne Smith, Brad Christensen, Teresa Rummans

Affiliations

Affiliation

¹ Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.

PMID:
16752968
DOI:
10.1089/jpm.2006.9.631

Domingo G Pérez et al.

J Palliat Med.

2006 Jun.

. 2006 Jun;9(3):631-7.

doi: 10.1089/jpm.2006.9.631.

Authors

Domingo G Pérez¹, Charles L Loprinzi, Jeff Sloan, Paul Novotny, Debra Barton, Lisa Carpenter, Deanne Smith, Brad Christensen, Teresa Rummans

Affiliation

¹ Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.

PMID:
16752968
DOI:
10.1089/jpm.2006.9.631

Abstract

Bupropion is commonly used in the treatment of nicotine dependence and depression, and in most people, does not cause sexual dysfunction, weight gain, or sedation. Given its attractive side effect profile, the efficacy of other newer antidepressants against hot flashes and anecdotal observations of resolution of hot flashes in some patients taking bupropion for nicotine dependence, it was decided to explore its clinical activity as a hot flash remedy in a pilot study. Between January 1999 and October 2004, 21 patients (7 men and 14 women) were enrolled in the study. Self-completed daily hot flash diaries were used to document the frequency and severity of hot flashes at baseline (week 1) and during the treatment period (weeks 2 through 5). Participants received bupropion 150 mg every morning for the first 3 days and then 150 mg twice per day for a total of 4 weeks. One woman did not provide any hot flash information and was excluded from the analysis. Five women could not complete the study because of side effects. The study did not show a reduction in hot flash frequency and/or severity significantly higher than what would be expected with a placebo. Even though the sample size was small, these results are consistent with bupropion’s mechanism of action (norepinephrine reuptake inhibition without serotonergic effects) and what it is now hypothesized about the pathophysiology of hot flashes (increased noradrenergic activity and decreased serotonergic activity). These data suggest that bupropion should not be further investigated as a remedy for hot flashes.

Cited by

A systematic review of non-hormonal treatments of vasomotor symptoms in climacteric and cancer patients.
Drewe J, Bucher KA, Zahner C.
Drewe J, et al.
Springerplus. 2015 Feb 10;4:65. doi: 10.1186/s40064-015-0808-y. eCollection 2015.
Springerplus. 2015.
PMID: 25713759
Free PMC article.
Efficacy of nonestrogenic hot flash therapies among women stratified by breast cancer history and tamoxifen use: a pooled analysis.
Bardia A, Novotny P, Sloan J, Barton D, Loprinzi C.
Bardia A, et al.
Menopause. 2009 May-Jun;16(3):477-83. doi: 10.1097/gme.0b013e31818c91ca.
Menopause. 2009.
PMID: 19188850
Free PMC article.

MeSH terms

Substances

Treating Sexual Difficulties in Menopause

CAROLINE WELLBERY, MD

Am Fam Physician. 2007;76(11):1717

Background: Women often experience changes in sexual function after menopause. Although changes in desire are not inevitable, postmenopausal women consistently experience a decrease in arousal, manifested by decreases in genital perfusion, engorgement, vaginal lubrication, and response to touch and vibration. Many also experience a decrease in the intensity of orgasm.

In addition to the physiologic changes that occur during menopause (most likely because of a drop in estrogen), psychological factors and expectations may also play a role in sexual satisfaction. Iatrogenically, surgical treatment of stress incontinence and hysterectomy have variable effects on sexual function, depending on preoperative factors and surgical technique. Atherosclerosis and hyperglycemia can impair sexual function in women, as can certain medications, such as selective serotonin reuptake inhibitors and dopamine receptor blockers.

Recommendations: Evaluation should include a comprehensive medical, sexual, and psychosocial history. A genital examination should include evaluation of resting pelvic floor muscle tone and voluntary vaginal and anal sphincter tone. Laboratory testing such as testosterone measurement is not indicated. However, targeted testing is appropriate for suspected disorders.

Treatment addressing sexual complaints should take into account the importance of sex to the patient. Other treatment recommendations include addressing unrealistic expectations, using lubricants, and creating romantic environments. Sex therapy can be helpful for psychological problems.

Estrogen improves vaginal lubrication and may improve orgasm. Although high doses of estrogen can achieve central effects that are more broadly beneficial to sexual function, the progesterone required for endometrial protection negates many of these benefits. If estrogens are used in patients who have an intact uterus and no risk factors, transdermal formulations should be prescribed, because oral estrogens increase sex-hormone binding globulin and decrease desire. Vaginal estrogen increases lubrication, may increase vasocongestion, and is safer than systemic estrogen, but long-term use should be avoided. Combination estrogen/testosterone increases sexual desire and responsiveness but lowers high-density lipoprotein cholesterol levels. Using a testosterone patch may avoid this adverse effect and, in combination with systemic estrogen, may improve the number of satisfying sexual episodes.

Other medications that may be helpful include bupropion (Wellbutrin) and phosphodiesterase inhibitors. Bupropion may increase arousal and orgasm completion. Phosphodiesterase inhibitors increase genital perfusion but have no significant effect on arousal. A subgroup of women taking phosphodiesterase inhibitors had improved overall satisfaction with changes in vaginal lubrication, genital sensation, and ability to achieve orgasm. The same cautions that apply to men in the use of these agents are relevant to women.

Several mechanical devices are available. Vibrators supply high-intensity, direct clitoral stimulation. A hand-held vacuum pump also increases clitoral blood flow and has been shown to increase sexual satisfaction. Some data suggest that pelvic floor exercises can be beneficial and can decrease sexual incontinence. New products to improve desire—including androgen delivery systems and dopamine agonists—as well as agents targeting genital arousal are currently in development.

Menopause

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Menopause

[ii] United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Aging 2019: Highlights (ST/ESA/SER.A/430). https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf

[iii] UNAIDS. The Gap Report 2014: People aged 50 years and older. Geneva, Switzerland. (2014). UNAIDS. https://www.unaids.org/sites/default/files/media_asset/12_Peopleaged50yearsandolder.pdf

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Key Facts

Menopause is one of the stages in a woman’s life cycle that marks the end of reproductive age. After menopause, a woman cannot become pregnant except in rare cases when special fertility treatments are used.
Most women experience menopause between the ages of 45 and 55 as a natural part of biological aging.
Menopause occurs as a result of the decline in ovarian follicular function and a decrease in circulating estrogen levels.
The menopausal transition can be gradual. It usually starts with changes in the menstrual cycle. “Perimenopause” means the period that begins with the onset of the first signs and ends one year after the last menstrual period.
Perimenopause can last for several years, affecting physical, emotional, mental and social well-being.
Symptoms of perimenopause can be alleviated with various non-hormonal and hormonal agents .
Menopause may result from surgical or medical procedures.

How does menopause proceed?

For most women, menopause is associated with the cessation of monthly periods (also known as “periods”) due to the decline of ovarian follicular function. This means that the ovaries stop releasing eggs for fertilization.

The regularity and length of the menstrual cycle varies during a woman’s reproductive life, but the age of natural menopause for women worldwide is typically between 45 and 55 years of age.

Natural menopause is considered to occur after the absence of menses for 12 consecutive months without any other obvious physiological or pathological causes and in the absence of clinical intervention.

Some women experience menopause earlier (before age 40). This “premature menopause” may be due to certain chromosomal abnormalities, autoimmune disorders, or other unknown causes.

It is impossible to predict when a woman will go through menopause, although there are links between the age of menopause and several demographic, medical and genetic factors.

Menopause may also occur as a result of surgery to remove both ovaries or medical interventions that suppress ovarian function (eg, radiation therapy or chemotherapy).

Many women stop menstruating before menopause, such as those who have undergone certain surgeries (hysterectomy or surgical removal of the lining of the uterus) and those who take certain hormonal
contraceptives and other medicines that lead to infrequent or no periods. However, they may experience other changes associated with the menopausal transition.

Changes associated with menopause

Hormonal changes associated with menopause can affect physical, emotional, mental and social well-being. The symptoms experienced during and after the menopausal transition vary significantly from woman to woman. Some have symptoms
practically absent. Others may experience severe symptoms that can affect daily activities and quality of life. Some may experience symptoms for several years.

Symptoms associated with menopause include the following:

hot flashes and night sweats. Hot flashes are sudden sensations of heat in the face, neck, and chest, often accompanied by reddening of the skin, sweating (sweating), rapid heart rate, and intense physical discomfort.
which may last several minutes;
changes in the regularity and course of the menstrual cycle, ending in the cessation of menstruation;
vaginal dryness, pain during intercourse and urinary incontinence;
difficulty sleeping/insomnia; and
mood changes, depression and/or anxiety.

These changes may also affect the composition of body tissues and increase the risk of cardiovascular disease. The advantage of women over men in terms of the risk of developing cardiovascular diseases is gradually decreasing.
not with a significant drop in estrogen levels after menopause. Menopause can also lead to weakening of the pelvic floor structures, which increases the risk of pelvic organ prolapse. Loss of bone density during menopause is significant
a factor contributing to an increase in the incidence of osteoporosis and fractures.

There are a number of non-hormonal and hormonal agents that can help relieve menopausal symptoms. Symptoms that affect health and well-being should be discussed with a healthcare professional to determine available options
their relief, taking into account medical history, values and preferences.

Pregnancy is still possible during perimenopause. To avoid unwanted pregnancy, it is recommended to use contraceptives for 12 consecutive months after the last menstrual period. Pregnancy after menopause without fertility treatment,
involving the use of donor eggs or previously frozen embryos is unlikely.

During perimenopause and after menopause, sexually transmitted infections (STIs), including HIV, can still be contracted through unprotected sex, including oral, anal, and vaginal sex. Thinning of the walls of the vagina after
menopause increases the chance of damage and ruptures, which increases the risk of HIV transmission through vaginal sex.

The importance of understanding menopause

It is very important to consider menopause as one of the life cycle stages. The state of health of a woman entering the perimenopausal period is largely determined by the previous state of health, reproductive history, lifestyle and factors
environment. Perimenopausal and postmenopausal symptoms can be devastating to personal and professional life, and the changes brought about by menopause impact a woman’s health as she ages. Therefore rendering
Perimenopausal health care plays an important role in promoting healthy aging and improving quality of life.

Menopause can be an important transitional period, both socially and biologically. Socially, how a woman experiences menopause can be influenced by gender norms, family and sociocultural factors, including how aging
women and the menopausal transition are accepted in her culture.

The global population of postmenopausal women is growing. In 2021, women aged 50 and over made up 26% of all women and girls in the world. This figure has increased from 22% 10 years earlier[i]. In addition, the life expectancy of women is longer
than in men. In 2019d. women aged 60 worldwide could expect to live an average of 21 more years[ii].

Menopause can be an important opportunity to reassess your health, lifestyle, and goals.

Menopause-related public health issues

Perimenopausal women need access to quality health care and to communities and systems that can support them. Unfortunately, awareness of and access to menopause services remains serious.
problem in most countries. Often, menopause-related issues are not discussed in families, communities, workplaces, and health care settings.

Women may not be aware that the symptoms they experience are associated with menopause and that there are counseling and treatment options available to help relieve discomfort. Women experiencing menopausal symptoms may feel uncomfortable
or shame that prevents them from drawing attention to their experiences and asking for support.

Health care providers may not be trained to recognize perimenopausal and postmenopausal symptoms and counsel patients about treatment options and health care after the menopausal transition. Currently in programs
The training of many medical professionals has given limited attention to the problem of menopause.

In many countries, the sexual well-being of menopausal women is neglected. This means that common gynecological effects of menopause, including vaginal dryness and pain during intercourse, may remain.
without attention. Similarly, older women may not consider themselves at risk of contracting sexually transmitted infections, including HIV[iii], and may not receive safe sex or testing advice from their doctors.

Many governments do not have the health policy and funding to include diagnostic, counseling and treatment services for menopause as part of routine services. Menopause services are
presents a particular challenge in the presence of other urgent and competing health financing priorities.

WHO activities

WHO believes that social, psychological and physical health support during the menopausal transition and after menopause should be an integral part of health care. WHO aims to improve understanding of menopause through
following events:

raising awareness of menopause and its impact on women at the individual and community levels, as well as on the health and socioeconomic development of countries;
advocacy for the inclusion of diagnostic, treatment and counseling services for menopausal symptoms in the universal health coverage package;
Promoting the inclusion of menopause education and treatment options in pre-service training programs for health workers; and
promoting a lifelong approach to health and well-being (including sexual health and well-being) by ensuring that women have access to relevant health information and services to promote healthy
aging and a high quality of life before, during and after menopause.

Notes:

and self-identify as women), transgender men and some individuals who do not identify as either male or female are also going through menopause.

In this fact sheet, “women” are referred to according to available data, which usually does not specify gender identity. There is little data available on the experience of menopause among transsexuals and individuals with
gender identity. Transgender people and individuals with different gender identities have their own age-related health needs that clinicians should consider, including referral to specialized
services.

2) Although menopause is not a disease, in this fact sheet what women experience during perimenopause and postmenopause is
called symptoms because it can cause discomfort that affects quality of life.

[i] United Nations, Department of Economic and Social Affairs. (2021) World Prospects 2021. https://population.un.org/wpp/Download/Standard/Population/

[iii] UNAIDS. The Gap Report 2014: People aged 50 years and older. Geneva, Switzerland. (2014). UNAIDS. https://www.unaids.org/sites/default/files/media_asset/12_Peopleaged50yearsandolder.pdf

Women’s Health

Sexual and Reproductive Health and Research (English)

Aging

Sexual health

What is menopause – menopause, symptoms of menopause.

Menopause or menopause is a natural period in a woman’s life, when the hormonal balance in the body changes, decreases, and then completely disappears the possibility of becoming pregnant, menstruation stops. The ovaries produce less sex hormones as a result of the aging process.

Menopause (menopause) is not a disease, but a physiological restructuring of the body. For some menopause goes unnoticed, while others have a number of complaints. It can last several years and consists of three stages.

Stages of menopause (menopause)

Perimenopause is a transitional period that begins, on average, 4 years before menopause (ages 45-47) and continues for 12 months after the cessation of menstruation. The first sign of perimenopause is changes in the menstrual cycle, both in duration and in the amount of blood loss. In the last one to two years of perimenopause, the fall in estrogen accelerates. At this stage, symptoms of menopause are observed. Women still have menstrual cycles and can become pregnant.
Menopause is the time of the last natural bleeding (menses). Begins either 12 months after the last menstrual period, or after the cessation of menstruation for a clinical reason.
Postmenopause – the period when a woman has not had bleeding within a year after menopause, which continues until 65-69 years, gradually passing into the period of reproductive aging.

Why does menopause occur?

Natural menopause occurs at the beginning of the age of 50, when it is not caused by surgery or other disease. But there are reasons that can provoke an artificial menopause.

Natural reduction of reproductive hormones .

As a woman approaches her 40s, the ovaries begin to produce less estrogen and progesterone, the hormones that regulate menstruation, and fertility declines. Menstrual periods become longer or shorter, heavier or lighter, and more or less frequent. On average, by the age of 51, they stop.

Primary ovarian failure.

About 1% of women experience menopause before the age of 40 (premature menopause). It may be the result of an inability of the ovaries to produce normal levels of reproductive hormones, which is due to genetic factors or autoimmune diseases (decreased immune defenses). Often, the cause of premature menopause cannot be found. Hormone therapy is usually recommended for these women, at least until the natural age of menopause, to protect the brain, heart, and bones.

Surgery to remove the ovaries (oophorectomy).

Surgery causes immediate menopause. Periods stop and menopausal symptoms begin to appear. They can be serious because hormonal changes happen suddenly rather than gradually over several years.

Surgery to remove the uterus (hysterectomy) ,

usually does not cause immediate menopause. Although menstruation has stopped, the ovaries still produce estrogen and progesterone.

Chemotherapy and radiotherapy.

These cancer treatments may induce menopause and its symptoms during or shortly after treatment. The cessation of menstruation and fertility do not always occur. Radiation therapy affects the function of the ovaries only if the radiation is directed at them. Therapy of other parts of the body will not affect menopause.

Symptoms of menopause

According to statistics, approximately 30% of women experience menopausal disorders, another 30% – in an aggravated form. During menopause, various physical and mental changes occur.

Changes associated with perimenopause and menopause include:

Lower fertility

As a woman approaches the end of the reproductive stage, but before the onset of menopause, estrogen levels begin to drop. This reduces the chances of getting pregnant.

Irregular menses

The first sign of approaching menopause is less regular periods. They may come less often or more often, they may be heavier or lighter.

Vaginal dryness and discomfort

Vaginal dryness, itching and discomfort may begin during perimenopause and continue into menopause. A woman with any of these symptoms may experience irritation and discomfort during intercourse. Various moisturizers, lubricants, and medications reduce vaginal dryness and related problems.

Tides

Hot flashes often occur during menopause. They cause a sudden sensation of warmth in the upper body. The flush may start in the face, neck, or chest and progress up or down. The duration of each is up to 1-2 minutes. Various factors can provoke – climate change, stress.

Psycho-emotional changes

Depression, anxiety and low mood are common during menopause. Often there are bouts of irritability and crying.

Sleep disorders

During menopause, sleep disorders, constant feelings of weakness, decreased performance, memory and concentration may begin.

Physical changes

Physical changes may develop during menopause, such as:

weight gain;
changes in color, texture and volume of hair;
skin problems;
reduction and pain in the chest;
Urinary incontinence.

Complications

After menopause, the risk of certain diseases increases. Examples include:

Heart and vascular disease (cardiovascular) . When estrogen levels decrease, the risk of cardiovascular disease increases. Heart disease is the leading cause of death for both women and men. Therefore, it is important to exercise regularly, eat a healthy diet and maintain a normal weight. Ask your doctor for advice on how to protect your heart, such as how to lower your cholesterol or blood pressure if it’s too high.

Osteoporosis. This condition causes bones to become brittle and weak, which increases the risk of fractures. During the first few years after menopause, bone density can be lost rapidly, increasing the risk of osteoporosis. Postmenopausal women with osteoporosis are particularly susceptible to fractures of the spine, hips, and wrists.

Urinary incontinence. The tissues of the vagina and urethra lose their elasticity, resulting in a sudden and intense urge to urinate, which can develop into incontinence. Strengthening the pelvic floor muscles, with Kegel exercises and topical vaginal estrogen, can help relieve these symptoms. Hormone therapy is also an effective treatment option.

Sexual function. Vaginal dryness due to decreased moisture production and loss of elasticity may cause discomfort and slight bleeding during intercourse. In addition, decreased sensitivity affects sexual activity (libido). Vaginal moisturizers and water-based lubricants may help. If this is not enough, estrogen treatment available as a vaginal cream, tablet, or ring can be used.

Weight gain. Many women gain weight during and after menopause due to slow metabolism. In this case, you have to change your eating habits and exercise more to maintain your current weight.

How is menopause (menopause) diagnosed?

A gynecologist can diagnose menopause in several ways:

The first is a discussion of the menstrual cycle over the past year.

Another way is the FSH blood test, which checks the level of follicle stimulating hormone. FSH analysis is a regulator of the development of ovarian follicles in the female body. However, this test can be misleading at the onset of menopause when the body is in transition and hormone levels fluctuate up and down.

A hormone test should always be interpreted in the context of what is happening with the menstrual cycle.

Prevention of menopausal disorders

Eat a healthy diet. Proper nutrition contributes greatly to the overall health of a person. During menopause, the diet should contain a variety of fruits, vegetables, and grains. Eliminate fatty, spicy, salty foods from your diet. Reduce the consumption of meat, sausages, smoked meats. Take supplements with calcium, vitamin D, supplements with Omega 3 polyunsaturated fatty acids every day (dosage will help you choose a doctor). Drink alcohol and caffeine in moderation. Do not smoke.
It is important for menopausal women to drink plenty of water : experts recommend drinking about 1. 5-2 liters per day. Water replenishes the fluid lost after excessive sweating during hot flashes and reduces their frequency.
Exercise (at least half an hour a day), try to stay active, this will help reduce hot flashes and prevent osteoporosis.
Do not wear synthetic fabrics . Synthetic fabrics impair heat transfer and impair ventilation, which contributes to overheating and an increase in the frequency of hot flashes. In addition, synthetic clothing absorbs moisture worse and accelerates the appearance of an unpleasant sweat odor. It is better to give preference to clothes made of cotton, linen or viscose. These recommendations also apply to bed linen.
Don’t overstress . Tension, stress, fatigue provoke the appearance of hot flashes, so a woman during menopause should not take on too many responsibilities. Do not try to do everything at once, alternate work with rest, pay attention to your health. A good night’s sleep is important, it significantly reduces stress levels and reduces the frequency of hot flashes.

Treatment of menopause (menopause)

Menopause is a natural process. Many symptoms disappear over time. But if they’re causing problems, treatment can help you feel better.

Hormone replacement therapy (HRT). Taking hormone replacement drugs that are no longer produced in the body. Certain menopausal medications or combinations of them can help with hot flashes and vaginal symptoms, as well as strengthen bones. But they can also put you at risk for health problems like heart disease or breast cancer, so you should take the lowest dose that works for the shortest amount of time.
Local hormonal therapy. This is an estrogen cream or gel that is inserted into the vagina to relieve dryness.
Non-hormonal preparations. Includes drugs for depression, insomnia, blood pressure, and others.

Wellbutrin menopause: Pilot evaluation of bupropion for the treatment of hot flashes

Pilot evaluation of bupropion for the treatment of hot flashes

Affiliation

Authors

Affiliation

Abstract

Similar articles

Cited by

MeSH terms

Substances

Treating Sexual Difficulties in Menopause

Menopause

What is menopause – menopause, symptoms of menopause.

Stages of menopause (menopause)

Why does menopause occur?

Symptoms of menopause

Complications

How is menopause (menopause) diagnosed?

Prevention of menopausal disorders

Treatment of menopause (menopause)

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