Managing Hot Flashes from a Medical Perspective

Perhaps the most disruptive and frustrating symptom of menopause is the hot flash, or hot flush as they are often called in medical literature. These are common vasovagal symptoms which occur in response to reductions in estrogen levels causing an overwhelming feeling of heat surging through the body. Many women have occasional mild hot flashes, whereas others may have debilitating frequent ones that disrupt their ability to function well during the day and/or disrupt their ability to sleep at night. Some women literally sweat their way through menopause without medications. But if your hot flashes are frequent enough and severe enough to interfere with your ability to fulfill those roles that are most important to you - as wife, partner, mother or employee - then help may be necessary.

Since hot flashes are caused by lack of estrogen, replacing estrogen with Hormone Replacement Therapy (or HRT) is the most effective remedy. Many women have a strong fear of HRT based on information gained from a large study of HRT use in older post menopausal women (average age 65) called the Women's Health Initiative Study (WHI). This research demonstrated a slight increase in invasive breast cancer in older women on Prempro for 5 years or longer. What we learned from this study is that HRT use in post-menopausal women may be of greater risk than benefit; but for young perimenopausal women who are experiencing the most symptoms, low dose HRT can be very safe and highly effective.

The goal in HRT management is to find the lowest dose that controls symptoms so that the individual can function better. We then keep that person on HRT for only a brief time with the intent of eventually weaning her off HRT so she experiences a more comfortable transition. For most women, a brief course of low-dose HRT can be very safe. No other remedy has been clinically proven to be as effective as HRT in controlling hot flashes. But there are some women for whom HRT may be unsafe, including those with a personal history of breast cancer, certain genital cancers, or a prior history of developing a blood clot or pulmonary embolism while pregnant or on hormonal birth control.

Some non-medical suggestions for managing vasomotor symptoms include wearing layers or lighter clothing, improving one's sleep environment, reducing the amount of bedding, providing a cool cloth or cool mist when hot flashes hit, following a regular exercise program and minimizing alcohol.

There are many over the counter herbal medications which have phytoestrogens (plant-derived compounds that are chemically similar to estrogen) that are touted for the control of hot flashes. These include soy, black cohosh, red clover, and Mexican yams, just to name a few. In placebo-controlled studies, all of these seem to have a modest effect on improving hot flashes. Keep in mind that these herbal products are not FDA regulated, so there is no obligation for the companies that manufacture them to demonstrate either efficacy or safety. There are also non-hormonal prescription options, such as SSRI antidepressants, which have been demonstrated to be quite effective in controlling vasomotor symptoms in some patients.

Selecting the right option for you is a highly individualized process, warranting a detailed conversation with a medical professional that is familiar with you, your personal history and your family medical history, in order to determine the safest, most effective treatment options.