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Should I treat my hot flashes or wait them out?

by Margery Gass | Dec 16, 2014

It is really your choice. If your hot flashes are not bothering you that much, you may want to just wait them out. Hot flashes generally become milder and less frequent as time goes on, and for most women they totally disappear. However, there are some women who have a long experience with hot flashes for several years, maybe longer, and then an occasional hot flash forever. The challenge is that no one can predict how long your hot flashes will persist. Hormone therapy provides very effective treatment for hot flashes, but it is not always a permanent cure. About forty percent of women have a return of their hot flashes when they stop treatment—somewhat like a second menopause when the estrogen level drops again.

There are a number of low-risk coping strategies and lifestyle changes that may be helpful to you for managing hot flashes, but if hot flashes remain very disruptive then prescription therapy can be considered. Prescription hormone therapy (HT) approved by the US Food and Drug Administration (FDA) and by Health Canada include systemic estrogen therapy (ET) and estrogen-progestogen therapy (EPT; for women with a uterus). Some of these treatments have been around for 70 years. A newer FDA-approved hormone product, for women with a uterus, combines estrogen with bazedoxifene instead of a progestogen. Bazedoxifene is an estrogen agonist/antagonist, which means that it works like estrogen in some tissues while inhibiting estrogen activity in others. In this case, it helps to protect the uterus from cancer. There are reasons why some women should not use HT and the list includes such things as a history of estrogen-related cancers such as breast cancer, a history of liver disease, blood clots in the legs or lungs, cardiovascular disease, and stroke. A review of your health history with your healthcare provider is an important first step.

For women who prefer not to take hormones or cannot take them for other health reasons, nonhormonal drugs approved to treat depression, called selective serotonin-reuptake inhibitors (SSRIs), have been found to be effective in treating hot flashes in women who don’t have depression. The only SSRI the FDA has approved thus far for treating hot flashes is paroxetine 7.5 mg. It was shown to improve hot flashes and offers women a new choice. Discuss with your healthcare provider all of these options to see which ones are appropriate for you. 

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  1. 2 Donna trembly 30 Dec
    you didn't  talk about the difference between transdermal and oral bioidentical hormones.  Therefore it is not a one size fits all therapy for patients 
  2. 1 judy irwin 17 Feb
    I had a complete hysterectomy in 1990 and soon thereafter began experiencing hot flashes and night sweats. My doctor had me start Estradiol, and I took it 12 years until I was diagnosed with DCIS beast cancer. I had a double mastectomy and reconstruction in 2004 and stopped the HRT. Unable to control the hot flashes, I started progesterone and DHEA and Cortrex that have helped, but I still get hot flashes when the weather is hot and humid or when my husband snuggles with me. I am now 65 years old and have been experiencing hot flashes and night sweats for 35 years. I have always know that I am also a DES baby (a hormone treatment my mother took while pregnant with me to stop possible miscarriage). Years later with the advent of the Internet, I discovered all the side effects that drug had. Posible effects are cervical dysplasia, which I had, birth defects (I thought I had a large mole on the underside of one breast, but during my mastectomy learned it was an extra nipple), and beast cancer. This drug will also will have possible effects on my sons and their children. My mother had a hysterectomy (after which her long standing migraine headaches stopped), but she never had one hot flash. No one ever does studies on hot flashes for women who have had breast cancer, so we continue to suffer. Anti-depression drugs scare me because of the side effects. Just wondering how many other women have had hot flashes for many years with little relief. I would start taking HRT again if I could find a doctor to prescribe them. Quality of life is better than quantity of life.


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