Hot flushes and serotonin

Abstract

Hot flushes are experienced by the majority of menopausal women especially in the perimenopause. They are the most characteristic menopausal symptom. Hypogonadal men also suffer from hot flushes. Enough evidence exists to suggest that oestrogen withdrawal is probably the main cause of hot flushes. They are mainly experienced when circulating oestrogen levels are low and are successfully treated by replacing this steroid. However, it is clear that other non-hormonal mechanisms play an important role in the pathophysiology of hot flushes. The neurotransmitter serotonin seems to be especially involved. This review examines the involvement of serotonin in hot flushes and especially the role of the 5-HT_2A receptor subtype. It is concluded that non-hormonal treatment with either 5-HT_2A receptor antagonists or 5-HT_2C receptor agonists may have several advantages over hormonal therapy.