From the Guidelines
Hot flashes can be effectively managed with lifestyle modifications and non-hormonal medications, prioritizing the reduction of morbidity, mortality, and improvement of quality of life. To manage hot flashes, start with lifestyle modifications such as dressing in layers, avoiding triggers like spicy foods, alcohol, and caffeine, maintaining a cool environment, and practicing stress reduction techniques like deep breathing or meditation, as suggested by the NCCN guidelines 1.
Lifestyle Modifications
- Weight loss: Losing ≥10% of body weight can help eliminate hot flash symptoms, as seen in the Women’s Health Initiative Dietary Modification trial of 17,473 postmenopausal women not taking menopausal hormone therapy (MHT) 1.
- Quitting smoking: Improvements in the frequency and severity of hot flashes have been observed in women who quit smoking compared to those who continued to smoke 1.
- Limiting alcohol intake: If alcohol triggers hot flashes in an individual, limiting intake is recommended 1.
- Cognitive Behavioral Therapy (CBT): CBT has been shown to reduce vasomotor symptoms in the general population and in cancer and survivor populations, with studies suggesting that CBT lessens the perceived burden of hot flashes 1.
Non-Hormonal Medications
- Selective serotonin-norepinephrine reuptake inhibitors (SNRIs): Venlafaxine has been found to be safe and effective in reducing hot flashes, with a typical dose of 37.5-75mg daily 1.
- Selective serotonin reuptake inhibitors (SSRIs): Paroxetine has been shown to reduce the frequency and severity of hot flashes, although it should be used with caution in women taking tamoxifen due to potential interactions 1.
- Gabapentin: This anticonvulsant has been shown to improve menopause-related vasomotor symptoms, with a typical dose of 300mg at bedtime 1.
- Clonidine: This antihypertensive has been used in clinical practice to reduce hot flashes, with a typical dose of 0.1mg twice daily 1.
It is essential to consult with a healthcare provider before starting any treatment to determine the most appropriate option based on medical history and symptom severity, considering the potential benefits and risks of each treatment option, as well as the individual's overall health and well-being 1.
From the FDA Drug Label
On the NSABP P-1 trial, hot flashes of any severity occurred in 68% of women on placebo and in 80% of women on tamoxifen. Severe hot flashes occurred in 28% of women on placebo and 45% of women on tamoxifen
- Hot flashes are a common side effect of tamoxifen, occurring in 80% of women on tamoxifen compared to 68% of women on placebo.
- Severe hot flashes occurred in 45% of women on tamoxifen compared to 28% of women on placebo 2
From the Research
Definition and Causes of Hot Flashes
- Hot flashes are defined as transient sensations of heat, sweating, flushing, anxiety, and chills lasting for 1-5 min 3.
- The basis of hot flashes lies in abnormal hypothalamic thermoregulatory control resulting in abnormal vasodilatory response to minor elevations of core body temperature 3.
- Estrogen deficiency plays a cardinal role in the causation of hot flashes, in addition to other factors such as calcitonin gene-related peptide, hypothalamic kisspeptin, neurokinin B and dynorphin signal system, serotonin, and norepinephrine 3.
Treatment Options for Hot Flashes
- Hormone replacement therapy (HRT) is considered the gold standard for management of vasomotor and vaginal symptoms of menopause, including hot flashes 4.
- HRT carries significant risks, including risk of stroke, cardiovascular disease, breast cancer, and venous thromboembolism 4.
- Nonhormonal alternatives such as low-dose paroxetine, venlafaxine, and gabapentin are effective alternatives for treating hot flashes 5.
- Lifestyle modifications, such as yoga and relaxation techniques, may be proposed as the first step in the management of less severe hot flashes, but further evidence is needed to support their effectiveness 6.
- Selective estrogen receptor modulators (SERMs) may be used as an alternative to hormonal therapy for postmenopausal women, but their use is controversial 7.
Management of Hot Flashes
- The mainstay of treatment for hot flashes includes hormonal replacement therapy, selective serotonin, and norepinephrine reuptake inhibitors in addition to lifestyle modification 3.
- A stepwise approach to the management of hot flashes is recommended, taking into account the severity of symptoms and the individual's medical history 3.
- Women with a uterus who are using estrogen should also take a progestogen to reduce the risk of endometrial cancer 5.
- Women who cannot tolerate adverse effects of progestogens may benefit from a combined formulation of estrogen and the selective estrogen receptor modulator bazedoxifene 5.