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Hot flashes are universally known as one of the signs of menopause, but they can complicate many other conditions. Individualized treatment is best.

For many women, hot flashes are synonymous with menopause.

About the time menstrual cycles become irregular (in most women, occurring about every 25 days instead of every 28), women begin to experience episodes of flushed skin, perspiration, and heat commonly known as hot flashes. It's not at all unusual to experience hot flashes. About 92 percent of women going through menopause do for one to five years and sometimes more. Women going through perimenopause, the transition to menopause, often experience irregular menstruation, weight gain and bloating, intimate dryness, headaches, insomnia, breast pain, and depression, but the nearly universal symptom of menopause is hot flashes.

What Can Doctors Do For Hot Flashes?

For women, hot flashes during menopause, hot flashes while pregnant, and hot flashes during the menstrual period are all linked to fluctuating levels of estrogen. For decades, the most common prescription for hot flashes has been supplemental estrogen. Estrogen replacement therapy doesn't eliminate hot flashes for most women who use it, but on average it reduces the number of hot flashes by about 75 percent. Not absolutely every woman who has hot flashes, however, actually needs estrogen replacement therapy.

  • Sometimes hot flashes, in both women and men, are caused by hyperthyroidism, an overactive thyroid.
  • Sometimes hot flashes are complicated by obesity. Weight loss, however, is never enough to get rid of hot flashes.
  • Sometimes hot flashes are due to the use of estrogen sequestration agents in the treatment of cancer. Unfortunately, estrogen replacement therapy would subvert the cancer treatment.

There are certain commonsense practices that usually improve symptoms. Cutting back on caffeine usually reduces the severity of hot flashes, as does reducing consumption of alcohol. Smoking cessation usually results in fewer hot flashes that are less severe. Having a portable fan, using the air conditioner, and dressing layers can all be helpful.

On the other hand, some approaches usually don't work really well.

  • Herbs like St. John's wort usually help, but aren't enough for moderate to severe hot flashes. Black cohosh (Remifemin) typically produces fewer side effects (such as diarrhea or sun sensitivity) than St. John's wort.
  • Exercise programs don't hurt, but usually don't help a lot, either.
  • Acupuncture and relaxation programs tend to work in women who expect them to work, which suggests a strong placebo effect. Of course, if it works, women don't care whether it's a placebo or not.

There are drugs that help women who have hot flashes. Some women respond well to a class of drugs known as norepinephrine reuptake inhibitors, a group of medications including Effexor (venlafaxine). Some women respond to selective serotonin reuptake inhibitors (SSRIs), such as Prozac, Brisdelle, Zoloft, Lexapro, and Priligy. Women may respond to gabapentin or clonidine.

  • Giving women testosterone may boost their sex drives (women are given much smaller doses than men), but it will do very little for hot flashes.
  • Sometimes the hormone replacement therapy contains both estrogen and progestin, but progestin alone is usually not successful.
  • Estrogen replacement therapy itself has a serious downside.

One of the serious problems with estrogen replacement therapy is that it is associated with increased risk of blood clots that cause deep vein thrombosis. These are blood clots that usually form in the legs and can travel to the heart. Another of the serious problems with estrogen replacement therapy is that it slightly increases the risk of estrogen receptor positive breast cancer. There is a way, however, of minimizing these risks.

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