From the Guidelines
Yes, hot flashes can persist into your 70s and beyond, affecting approximately 10-15% of women. While most women experience hot flashes for 7-10 years around menopause, the body's temperature regulation center in the hypothalamus remains sensitive to small changes in core body temperature even years after menopause, causing inappropriate vasodilation and the sensation of heat when triggered 1.
Treatment Options
Treatment options for hot flashes include hormone therapy (estrogen with or without progesterone) for those without contraindications, typically starting with low doses like 0.3-0.45 mg conjugated estrogens or equivalent. Non-hormonal medications like low-dose paroxetine (7.5 mg daily), venlafaxine (37.5-75 mg daily), or gabapentin (300 mg at bedtime) can also effectively reduce hot flash frequency and severity 1.
Lifestyle Modifications
Lifestyle modifications that may help include:
- Dressing in layers
- Avoiding triggers like spicy foods, alcohol, and caffeine
- Maintaining a cool bedroom temperature
- Practicing relaxation techniques
- Regular exercise
Gabapentin is a viable option for reducing hot flashes, with a rapid onset of action and minimal side effects 1. Unlike SSRI/SNRI, gabapentin has no known drug interactions, no absolute contraindications, does not cause sexual dysfunction, and appears to be well tolerated for this indication 1.
Recommendation
Gabapentin (300 mg at bedtime) is recommended as a first-line treatment for hot flashes in women who cannot take hormone therapy or prefer non-hormonal options 1. This recommendation is based on the most recent and highest quality study available, which suggests that gabapentin is at least as effective as SSRI/SNRI in reducing hot flashes, with a more favorable side effect profile 1.
From the Research
Hot Flashes in Postmenopausal Women
- Hot flashes affect about three fourths of postmenopausal women, and are one of the most common health problems in this demographic group 2.
- The frequency and severity of hot flashes can vary, with some women experiencing mild symptoms that do not interfere with sleep or daily function, while others experience more severe symptoms 2.
Treatment of Hot Flashes
- For mild symptoms, behavioral changes in conjunction with vitamin E (800 IU/d) use is a reasonable initial approach 2.
- For more severe symptoms, estrogen replacement therapy can be effective, relieving symptoms by about 80% to 90% in women who are able and willing to use estrogen 2.
- Alternative treatments, such as selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs), can also be effective in reducing hot flashes, with venlafaxine decreasing hot flashes by about 60% 2, 3, 4, 5.
- Other non-hormonal treatments, such as gabapentin and clonidine, may also be effective in reducing hot flashes 3, 4, 5.
Hot Flashes in Older Women
- There is limited information available on the duration of hot flashes in postmenopausal women, but it is known that hot flashes can persist for many years after menopause 2.
- Some studies suggest that hot flashes can continue into the 70s, although the frequency and severity of symptoms may decrease over time 6.
- Further research is needed to fully understand the duration and management of hot flashes in older women.