The role of serotonin in hot flushes

Hot flushes are experienced in those periods of the female life when estrog en levels are low. Hormone replacement therapy is thus the first choice for treatment of hot flushes. However this treatment is not always accepted or contraindicated for a variety of reasons. Estrogen (and progestogen) stron gly interact with a number of neurotransmitters and this has led to a range of non-hormonal treatments including compounds that act via the noradrener gic or dopaminergic systems as well as herbal remedies. These treatments (w hich are shortly reviewed) are not always successful. Surprisingly, apart f rom treatment with some selective serotonin (5-HT) reuptake inhibitors (SSR I's), up till now, little attention is given to the strong interaction of e strogens with the serotonergic system. These interactions are shortly revie wed. Based on these interactions, a hypothesis on the genesis of hot flushe s is postulated. Especially the 5-HT2A receptor subtype may play a key role in the occurrence of hot flushes. A number of arguments that support this hypothesis are discussed. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.