Amenorrhea is not listed in the EPAR of duloxetine (the unspecified menopausal symptoms are), but can be explained from a mechanistic point of view as it is a clinical manifestation of hyperprolactinaemia that is mentioned in the EPAR and is caused by raised levels of serotonin, which is a modulator of prolactin secretion [21]. Here, PRL is linked to hyperpituitarism.