How it works
Venlafaxine and desvenlafaxine are serotonin-norepinephrine reuptake inhibitors (SNRIs) commonly used as antidepressants. They are also used off-label for menopause vasomotor symptoms because they affect the brain pathways involved in temperature regulation and can reduce hot flash frequency and severity. They may also help with mood or anxiety in some users.
How well it works
The Menopause Society (NAMS 2023) lists SNRIs as an effective nonhormonal option for hot flashes and night sweats. Randomized trials have found that venlafaxine reduces patient-reported hot flush scores compared with placebo, but the magnitude varies by dose and outcome measure. Like other antidepressants used for hot flashes, the effect is generally smaller than hormone therapy but can be meaningful for people who cannot or prefer not to use hormones.
Side effects and cautions
Common side effects include nausea, headache, dry mouth, insomnia or drowsiness, dizziness, sexual dysfunction, and a small increase in blood pressure. Venlafaxine should not be combined with MAOIs or other serotonergic medicines without medical guidance. People with high blood pressure or kidney disease may need dose adjustments. This use is off-label in the United States.
Where to get it
You need a prescription, which you can get through telehealth or your primary care provider. Generic venlafaxine is usually inexpensive and often covered by insurance even for off-label use.
