From the Guidelines
For an 80-year-old female on estrogen experiencing hot flashes, initial laboratory evaluation should include a comprehensive metabolic panel, complete blood count, thyroid function tests (TSH, free T4), and follicle-stimulating hormone (FSH) levels, as recommended by the NCCN clinical practice guidelines in oncology 1. When evaluating hot flashes in this patient population, it is essential to consider the potential risks and benefits of hormone therapy, as outlined in the survivorship guidelines 1. The initial laboratory evaluation should aim to assess overall health status, rule out other causes of hot flashes, and monitor for potential side effects of estrogen therapy. Some key points to consider in the initial evaluation include:
- Comprehensive metabolic panel to assess liver function, as estrogen is metabolized by the liver 1
- Complete blood count to monitor for signs of thromboembolism or other hematologic abnormalities 1
- Thyroid function tests (TSH, free T4) to rule out thyroid disorders as a cause of hot flashes 1
- Follicle-stimulating hormone (FSH) levels to assess menopausal status 1
- Blood pressure measurement and cardiovascular risk assessment to monitor for increased cardiovascular and thromboembolic risks associated with estrogen therapy in this age group 1 The patient's estrogen dose and regimen should be reviewed, as inadequate dosing could explain persistent hot flashes, and consideration should be given to non-hormonal alternatives like gabapentin, selective serotonin reuptake inhibitors, or clonidine if estrogen therapy needs to be discontinued due to risks or contraindications in this advanced age group 1.
From the Research
Initial Labs for Hot Flashes in 80-Year-Old Female on Estrogen
- The patient's history, including the frequency and severity of hot flashes and their effect on daily function, should be carefully evaluated 2.
- For mild symptoms, behavioral changes and vitamin E (800 IU/d) may be a reasonable initial approach 2.
- For more severe symptoms, estrogen replacement therapy may be considered if there are no contraindications or personal reservations 2.
- Alternative treatments, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), may be prescribed for women who are unable or unwilling to use hormone therapy 3, 4.
- The choice of treatment should be patient-specific and begin with the lowest dose available 3.
Considerations for Estrogen Replacement Therapy
- Estrogen replacement therapy can successfully relieve hot flash symptoms by about 80% to 90% in women who are able and willing to use it 2.
- However, estrogen replacement therapy may not be suitable for women with a history of breast or uterine cancer 2.
- In such cases, alternative treatments, such as megesterol acetate or SSRIs/SNRIs, may be considered 2, 3.
Alternative Treatments for Hot Flashes
- SSRIs, such as paroxetine, citalopram, and escitalopram, have been shown to reduce the frequency and severity of hot flashes in menopausal women 3, 4.
- SNRIs, such as venlafaxine, have also been found to be effective in reducing hot flashes 2, 3.
- Lifestyle modifications, such as avoiding triggers and practicing relaxation techniques, may also be helpful in managing hot flashes 5.