Menopausal Symptoms

Hot flashes are related to hormonal changes as a result of chemotherapy, endocrine therapy or menopause.
They usually improve over time though some women may experience difficulty for years.

Pharmacological interventions can include:

  • Venlafaxine 37.5 to 75 mg once daily (safe for use with tamoxifen)
  • Citalopram 20 mg (safe for use with tamoxifen)
  • Clonidine 0.05 mg
  • Oxybutynin 2.5 mg od or bid (off label use)
  • Gabapentin – start with 100 mg od and titrate up over 1 month to maximum dose of 300 mg tid; side effects often limit use

Herbal remedies are strongly discouraged as most that are recommended for hot flashes contain estrogen
related compounds.

Vaginal dryness / dyspareunia:

  • Can become a significant problem with the use aromatase inhibitors (letrozole, anastrazole, exemestane)


  • Use of vaginal moisturizer (e.g. Replens TM) three times weekly AND a thick lubricant prior to sexual activity
  • Estrogen containing products are generally NOT recommended including topical preparations
  • Refer severe problems to a gynecologist