From the Guidelines
For a menopausal woman experiencing hot flashes, I would recommend starting with transdermal estrogen therapy, such as an estradiol patch 0.025-0.05 mg/day, due to its lower risk of venous thromboembolism and stroke compared to oral formulations 1. When considering hormone replacement therapy (HRT) for menopausal symptoms, it's essential to weigh the benefits and risks. The most effective treatment for vasomotor symptoms, such as hot flashes, is menopausal hormone therapy (MHT) 1.
- Key considerations for HRT include:
- The lowest effective dose should be used to manage symptoms
- Treatment should be individualized based on a woman's risks and medical history
- Alternatives to HRT should be tried first, especially in survivors of hormonally mediated cancers
- For women with an intact uterus, a progestogen must be added to estrogen therapy to prevent endometrial hyperplasia and cancer.
- Micronized progesterone may be preferred over medroxyprogesterone acetate due to lower rates of venous thromboembolism and breast cancer risk 1.
- Regular follow-up appointments are necessary to monitor treatment efficacy and potential side effects, and to reassess the need for continued HRT.
- The goal is to use the lowest effective dose for the shortest duration needed to manage symptoms, typically reassessing after 3-6 months.
- A thorough medical history should be taken to identify contraindications, such as a history of breast cancer, coronary heart disease, stroke, venous thromboembolism, or liver disease.
- Non-hormonal options, such as low-dose paroxetine or venlafaxine, can be considered for women who cannot or prefer not to take estrogen.
- Local hormonal treatments, such as vaginal estrogen preparations, can also be used to manage symptoms like vaginal dryness, and have been shown to be effective and safe in survivors of hormone-dependent cancers 1.
From the FDA Drug Label
Estradiol tablets are a medicine that contains estrogen hormones. Estradiol is used to: reduce moderate to severe hot flashes Start at the lowest dose and talk to your healthcare provider about how well that dose is working for you. Estrogens should be used at the lowest dose possible for your treatment only as long as needed
The type of HRT to start a menopausal female on who is experiencing hot flashes is estrogen hormone replacement therapy, specifically estradiol tablets. The treatment should be started at the lowest dose possible and used only as long as needed to reduce moderate to severe hot flashes 2.
From the Research
Treatment Options for Menopausal Hot Flashes
The most effective treatment for menopausal symptoms such as hot flashes is hormone therapy, which is the only treatment approved by the US Food and Drug Administration (FDA) for this indication 3.
Recommended Hormone Therapy
The FDA recommends using the lowest effective dose of hormones, and new low-dose preparations and new dosage forms of hormone therapy are available 3.
Mainstay of Treatment
The mainstay of treatment for hot flashes includes hormonal replacement therapy, selective serotonin, and norepinephrine reuptake inhibitors in addition to lifestyle modification 4.
Pathophysiology and Treatment
Hot flashes are triggered by small elevations in core body temperature acting within a reduced thermoneutral zone in symptomatic postmenopausal women, and estrogen ameliorates hot flashes by increasing the core body temperature sweating threshold 5, 6.
Managing Menopause
Hormone replacement therapy with estrogen, progesterone, or a combination is explored and shown to demonstrate symptom reduction in a large percentage of women, and nonhormonal treatment and alternative therapies are used to treat vasomotor symptoms if contraindications present to hormone therapy or for those who prefer fewer side effects 7.
Key Points to Consider
- Hormone therapy is the most effective treatment for menopausal hot flashes
- The FDA recommends using the lowest effective dose of hormones
- Hormonal replacement therapy is the mainstay of treatment for hot flashes
- Estrogen ameliorates hot flashes by increasing the core body temperature sweating threshold
- Nonhormonal treatment and alternative therapies are used to treat vasomotor symptoms if contraindications present to hormone therapy or for those who prefer fewer side effects