Menopause Hot Flashes

Hot flashes also known as vasomotor symptoms are extremely common, affecting approximately 75% of women as they go through menopause. Symptoms can begin during the perimenopausal transition and last from a few years to over 10 years. When moderate to severe, they can have a significant impact on quality of life, especially due to the associated sleep disturbances. These sleep disturbances may affect energy, mood and metabolism.

What are hot flashes and how do they occur?

Hot flashes are the sudden sensation of heat typically in the upper chest and face, most often caused by the decrease in estrogen levels during the perimenopause and menopause transitions. Episodes can last as long as 4 minutes and can be associated with sweating, anxiety, and palpitations. The symptoms can occur during the day or night.

The diagnosis is made clinically by classic symptoms during perimenopause or menopause, as determined by history and physical exam. If signs and symptoms are not classic, then evaluation for other causes of flushing may be needed, such as thyroid function testing to exclude hyperthyroidism.

For each woman triggers may be different but common triggers include:

• Eating spicy foods
• Warm liquids or caffeine
• Feeling stressed or anxious
• Drinking alcohol
• Smoking or being around cigarette smoke
• Warm temperatures 
• Discontinuing estrogen therapy

Treatment and management options

There are many treatment and management options to help with the estrogen fluctuation and symptoms that occur during menopause.

Lifestyle & Natural Remedies

• Minimize triggers
• Lose weight
• Wear layered clothing
• Practice slow or deep breathing, yoga or meditation
• Carry cool water or a personal fan
• Complimentary alternative medicines CAM

Non-hormonal therapies

1. Gabapentin - used for nighttime predominant symptoms
2. Selective Serotonin Reuptake Inhibitors (SSRIs  and SNRI) like citalopram, paroxetine, venlafaxine, and escitalopram are primarily used as antidepressants, but they have proven to be effective in treating hot flashes - used for symptoms both day and night

Hormonal therapies

Transdermal (through the skin) estrogen patches are favored over oral estrogens and micronized progesterone is favored over medroxyprogesterone

• Uterus present-estrogen and progesterone will be needed
• Uterus absent estrogen alone

Top 5 things to know:

1. Hot flashes are common
2. Triggers, such as spicy food and alcohol, should be identified
3. If cardiovascular and breast cancer risks are low, hormone replacement therapy can be considered and is quite effective in relieving symptoms
4. If you choose not to be on hormonal therapy or cannot be on hormonal therapy, non-hormonal therapies, such as SSRIs, SNRIs, and gabapentin can help diminish the intensity of hot flashes
5. Most herbal preparations have not shown any benefit and bioidentical hormones are discouraged

Questions to ask your healthcare provider

• What do you think are possible triggers for my hot flashes?
• Are there any lifestyle or dietary interventions that may diminish my symptoms?
• Should I consider medication for treatment of my symptoms?  Hormonal or non-hormonal?
• If you are interested in hormonal therapy: Am I a good candidate for hormonal therapy, specifically are my cardiovascular and breast cancer risks low?