By: Dr. Cynthia Abraham
Hot flashes are common: As many as 8 in 10 women in the United States have hot flashes around the time of menopause. And though hot flashes may be a fact of life, there’s no need to suffer through them without help.
Ob-gyns and other health care professionals can help you find relief, no matter how mild or severe your symptoms are. There’s a lot you can do on your own to feel better too.
Here, I’ll discuss the basics of hot flashes, and I’ll review different ways to manage your symptoms.
Hot flashes involve the sudden feeling of heat in the upper body, usually in the face, chest, or neck. They often last 1 to 5 minutes, and they can come with other symptoms too. You might notice
Hot flashes usually happen at least daily. In fact, about a third of women have more than 10 hot flashes per day. For some, hot flashes feel mild, but for others they are more severe and may seriously disrupt day-to-day life.
Sometimes hot flashes happen at night. These are called night sweats. They can wake you up repeatedly and leave you feeling drained and tired the next day.
Hot flashes often start in the years leading up to menopause (the time known as perimenopause). They may begin when you first start to skip periods.
You know you’ve reached menopause when you go a full year without any menstrual bleeding. The average age of a last period is 51. The year after your last period is often when hot flashes are most common.
Studies show a wide variety in how many years hot flashes usually last. Some studies show anywhere from 4 to 10 years may be typical. Some women continue to have hot flashes into their 60s and 70s.
To help with hot flashes, I usually recommend starting with lifestyle changes. These changes can all help:
Some people also use dietary supplements, like tofu, soy, and an herb called black cohosh. Talk with your ob-gyn if you are interested in trying these. They are not regulated, so there is no guarantee that they are safe or effective.
If lifestyle changes aren’t helping, there are many medication options that can help. These fall into two general categories: nonhormonal medications and hormonal medications (called hormone therapy). Hormone therapy is the most effective treatment for menopause symptoms, though it does come with some risks.
Some antidepressants have been found to be effective for the treatment of hot flashes. These are called selective serotonin reuptake inhibitors (SSRIs). One example is paroxetine.
Another prescription, an antiseizure medication called gabapentin, has helped my patients manage their hot flashes. A blood pressure medication called clonidine is another option, especially if you have high blood pressure.
There’s also a new pill called fezolinetant, which targets the brain activity that causes hot flashes. This may be an option for treating moderate to severe hot flashes.
Hormone therapy is a very effective option for treating menopause symptoms. It’s especially useful if you have lots of symptoms in addition to hot flashes, like vaginal dryness, mood changes, and issues with memory.
Estrogen is the main hormone used in hormone therapy. If you have had your uterus removed (a hysterectomy), you can take estrogen on its own.
If you still have a uterus, you may take estrogen along with the hormone progesterone (or the synthetic version called progestin). Otherwise, taking estrogen on its own could lead to an increased risk of uterine cancer and breast cancer.
A newer option involves taking a medication that combines estrogen with a drug called bazedoxifene. Estrogen combined with bazedoxifene is also used for preventing osteoporosis.
When it comes to estrogen, I tell patients about the small increased risk of getting a blood clot in a deep vein (called deep vein thrombosis, or DVT). There’s also a small increased risk of a blood clot getting stuck in an artery in the lung, called pulmonary embolism.
Estrogen is usually taken by mouth or with skin patches, gels, or creams. The patches, gels, and creams come with a lower risk of blood clots than the pills.
Progesterone or progestin can also be taken by mouth. Or you can get progestin from an IUD (intrauterine device). The IUD is placed in the uterus and releases progestin for several years. It’s your choice whether to use pills or the IUD. Getting an IUD can be painful, but progesterone pills can have more side effects, like weight gain and mood changes.
Lifestyle changes, nonhormonal medication, and hormone therapy can all be very effective in treating hot flashes. Talk with your ob-gyn about what treatments are best for you. Together you can find a method that can help with your symptoms.
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