From the Guidelines
Hot flashes can be effectively managed with non-hormonal medications, lifestyle modifications, and environmental changes, prioritizing SNRIs, SSRIs, and gabapentin as first-line treatments. For mild symptoms, lifestyle modifications are recommended first, including wearing lightweight, layered clothing; using fans or air conditioning; avoiding triggers like spicy foods, alcohol, and caffeine; practicing stress reduction techniques like yoga or meditation; and maintaining a healthy weight 1.
Treatment Options
- Non-hormonal prescription medications, such as SNRIs (e.g., venlafaxine 75mg daily) and SSRIs (e.g., paroxetine 7.5mg daily), are effective in reducing hot flashes, with venlafaxine being a safe and effective option 1.
- Gabapentin (300mg at bedtime, increasing as needed) has also been shown to be effective in reducing hot flashes 1.
- Clonidine (0.1mg twice daily) may also help alleviate hot flashes, although its use is less common 1.
- Lifestyle interventions, including rhythmic breathing, exercise, and avoiding spicy foods, caffeine, and alcohol, have had variable results, but may be beneficial for some women 1.
- Environmental modifications, such as cool rooms and dressing in layers, can also be helpful in reducing hot flashes 1.
Considerations
- Systemic hormone therapy is rarely used to control menopausal symptoms in breast cancer survivors due to potential risks 1.
- Complementary therapies, such as acupuncture, have been studied, and some have been found to be minimally effective in reducing hot flashes 1.
- Natural remedies like black cohosh and soy isoflavones have limited scientific evidence supporting their use for hot flashes, and their effectiveness is uncertain 1.
Recommendations
- Primary care clinicians should offer SNRIs, SSRIs, gabapentin, lifestyle modifications, and/or environmental modifications to help mitigate vasomotor symptoms of premature menopausal symptoms 1.
- Patients should consult with their healthcare provider to determine the most appropriate treatment based on their medical history and symptom severity.
From the FDA Drug Label
TABLE 6 lists adverse reactions greater than or equal to 2 percent of women who received cyclic progesterone capsules 200 mg daily (12 days per calendar month cycle) with 0. 625 mg conjugated estrogens or placebo. ... Hot Flashes 11 35
The treatment option for hot flashes (vasomotor symptoms) is hormone therapy, specifically progesterone capsules with conjugated estrogens, as it shows a decrease in hot flashes from 35% in the placebo group to 11% in the treatment group 2.
From the Research
Treatment Options for Hot Flashes
The treatment options for hot flashes (vasomotor symptoms) include:
- Hormonal therapies, such as estrogens and progestogens, which are the most well-known effective agents in relieving hot flashes, but their safety is controversial 3, 4, 5
- Nonhormonal agents, such as:
- Newer antidepressant agents, like venlafaxine, which reduces hot flashes by about 60% 3
- Selective serotonin reuptake inhibitors (SSRIs), like paroxetine, citalopram, and escitolapram, which have been shown to reduce the frequency and severity of hot flashes 6, 7
- Serotonin-norepinephrine reuptake inhibitors (SNRIs), like venlafaxine and desvenlafaxine, which are effective in reducing hot flashes 7
- Anticonvulsant agents, like gabapentin, which is effective in reducing hot flashes 3
- Behavioral modifications, such as lifestyle changes, which are proposed as the first step in managing mild hot flashes 3, 5
- Complimentary therapies, such as:
- Paced respirations and hypnosis, which appear to be promising and warrant further investigation 3
- Acupuncture, which may warrant further investigation in reducing the frequency and severity of hot flashes 5
- Stellate ganglion block, which is a promising nonpharmacological therapy currently under investigation 3
Non-Recommended Treatments
The following treatments are not recommended due to lack of strong evidence: