5 Findings About Pregabalin for Hot Flashes

The trial enrolled women with frequent, bothersome symptoms

The registry for NCT00702949 records 207 women with at least 28 hot flashes weekly for a month. Participants had a history of breast cancer or wanted to avoid estrogen because of perceived breast-cancer risk. Previous gabapentin or pregabalin use excluded enrollment.¹

Two groups received pregabalin with target doses of 75 or 150 mg twice daily; the third received placebo.¹

The headline percentages combine frequency and severity

At six weeks, 163 women had outcome data. Median hot-flash scores fell approximately 65% and 71% with the lower and higher doses, versus 50% with placebo. The score combined frequency and severity; these percentages do not describe the proportion of women whose flashes disappeared.²

Frequency alone fell approximately 59%, 61% and 36%, respectively. Both doses outperformed placebo. Missing final-week data and short follow-up limit interpretation.²

The higher dose caused more side effects

Dizziness was more common with both doses than placebo; cognitive difficulties were more common with the higher dose. Its symptom diaries also showed greater concerns about weight gain, sleepiness, coordination and vision. Doses were increased gradually, so six treatment weeks did not mean six weeks at the target dose.²

The study compared pregabalin with placebo, not directly with gabapentin.²

The US society’s recommendation weighs more than symptom reduction

The Menopause Society’s³ 2023 statement does not recommend pregabalin for hot flashes. It cites limited studies, adverse effects including weight gain, and its US Schedule V controlled-substance status because of potential misuse. The same statement recommends gabapentin, a related but different medicine.³

A 2025 Spanish Menopause Society paper⁴ also includes pregabalin’s benefit in its treatment tables. That entry cites the same 2010 trial²; it is not a new replication or evidence of years-long benefit.⁴

An existing prescription needs an individual review

Hot-flash treatment is off-label under the US Lyrica prescribing information. The label calls for dose adjustment with reduced kidney function, warns about impaired driving from dizziness or sleepiness, and describes serious breathing risks, particularly alongside opioids or other sedating medicines, or with underlying breathing impairment.⁵

If you already take pregabalin for pain or seizures, ask how those benefits affect the decision. Discuss side effects and your complete medicine list. Do not stop abruptly: the label specifies a gradual taper over at least one week, arranged with the prescriber.⁵

The “Older Medicines, Newer Jobs” section of My Body Changed. Now What? explains nonhormonal prescribing options and differences between guidance. Our gabapentin prescribing questions address that separate medicine.