From the Guidelines
The most effective treatment for hot flushes in menopause is hormone replacement therapy (HRT), but for those who cannot or prefer not to use hormones, non-hormonal options like SNRIs, SSRIs, gabapentin, and lifestyle modifications are recommended. According to the American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline 1, primary care clinicians should offer SNRIs, selective serotonin reuptake inhibitors (SSRIs), gabapentin, lifestyle modifications, and/or environmental modifications to help mitigate vasomotor symptoms of premature menopausal symptoms.
Some key non-hormonal options include:
- SNRIs like venlafaxine (37.5-75mg daily)
- SSRIs like paroxetine (7.5-25mg daily)
- Gabapentin (300-900mg daily)
- Clonidine (0.1-0.2mg daily) Lifestyle modifications can also help, including:
- Dressing in layers
- Avoiding triggers like spicy foods, alcohol, and caffeine
- Maintaining a cool sleeping environment
- Practicing stress reduction techniques
- Regular exercise
The NCCN clinical practice guidelines in oncology 1 also suggest nonpharmacologic treatments, including acupuncture, exercise/physical activity, yoga, lifestyle modifications, weight loss if overweight or obese, hypnosis, and cognitive behavioral therapy (CBT) to manage hot flashes. However, the USPSTF recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women 1.
It's essential to weigh the benefits and risks of each treatment option and consider individual patient needs and preferences. Treatment duration varies, with symptoms typically lasting 1-5 years, though some women may need longer management.
From the FDA Drug Label
Estradiol is used to: reduce moderate to severe hot flashes Estrogens are hormones made by a woman's ovaries Between ages 45 and 55, the ovaries normally stop making estrogens. This leads to a drop in body estrogen levels which causes the “change of life” or menopause (the end of monthly menstrual periods). Sometimes, both ovaries are removed during an operation before natural menopause takes place. The sudden drop in estrogen levels causes “surgical menopause. ” When the estrogen levels begin dropping, some women develop very uncomfortable symptoms, such as feelings of warmth in the face, neck, and chest, or sudden strong feelings of heat and sweating (“hot flashes” or “hot flushes”).
The recommended treatment for hot flushes in menopause is estradiol, which is used to reduce moderate to severe hot flashes.
- The lowest effective dose should be used for the shortest duration consistent with treatment goals and risks for the individual woman.
- Patients should be reevaluated periodically (e.g., 3-month to 6-month intervals) to determine if treatment is still necessary 2.
- Estradiol should be used at the lowest dose possible for treatment only as long as needed, and patients should talk to their healthcare provider about how well the dose is working for them 2.
From the Research
Treatment Options for Hot Flushes in Menopause
- Hormone replacement therapy (HRT) is considered the most effective treatment for hot flushes, with a reduction in frequency of vasomotor symptoms by approximately 75% 3, 4, 5, 6
- HRT can be used for up to seven years, with appropriate evaluation of patients before initiating therapy to minimize complications 3
- Low-dose preparations and new dosage forms of hormone therapy are available, with the FDA recommending the use of the lowest effective dose of hormones 4
- Non-hormonal treatments, such as selective serotonin and norepinephrine reuptake inhibitors, can also be effective in reducing hot flushes, with a reduction in frequency of vasomotor symptoms by approximately 40% to 65% 7, 6
- Lifestyle modifications can also be beneficial in managing hot flushes 7
Recommended Treatments
- Systemic estrogen alone or combined with a progestogen can reduce the frequency of vasomotor symptoms by approximately 75% 6
- Oral and transdermal estrogen have similar efficacy in reducing hot flushes 6
- Bioidentical estrogens approved by the US Food and Drug Administration can also be used to treat vasomotor symptoms 6
- Non-hormonal approaches, such as citalopram, desvenlafaxine, escitalopram, gabapentin, paroxetine, and venlafaxine, can be effective in reducing hot flushes by approximately 40% to 65% 6