Gabapentin for Hot Flashes in Menopause

An underutilized treatment option

In my previous post I reviewed the various nonhormone therapies that are effective for hot flashes in menopause and I’ve also recently covered one of them, the new prescription medication called fezolinetant, in detail here. Continuing along this nonhormone theme for hot flashes I’m going to take a deeper dive into gabapentin, as in my opinion it is under prescribed.

I’d already been prescribing gabapentin for some time for chronic pain when research using this drug for hot flashes hit the presses, so I was able to quickly add it to my hot flash armamentarium. I see quite a lot of women in menopause who can’t take hormones for a variety of reasons, so between my pain and my menopause practices I have a lot of experience prescribing gabapentin.

Here I’m going to explain more about the medication in general, how it works, and some practical information for getting started (which can be helpful when your provider is willing to give you a prescription, but maybe isn’t as familiar with the medication). 

What is Gabapentin?

Gabapentin was first approved for use in the United States in 1993, is it’s been around for a long time and we have a lot of experience with it. Initially, the belief was that gabapentin worked like g-aminobutyric acid or GABA, which is an inhibitory neurotransmitter in the brain and hence the name gabapentin. When it became clear that gabapentin didn’t work on GABA receptors, it had this “no one really knows” asterisk.

In the last decade or so new research has emerged showing gabapentin inhibits a