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Menopause FAQS: Hot Flashes

As many as 75% of North American women have hot flashes during perimenopause, and nearly a quarter of them experience enough discomfort to seek relief from their clinicians. The NAMS experts offer some guidance by answering your questions to help you understand what is happening and why.

Q. What are hot flashes? What causes them to happen?
A. Hot flashes are the hallmark symptom of menopause. Although their exact cause still isn’t fully understood, hot flashes are thought to be the result of changes in the hypothalamus, the part of the brain that regulates the body’s temperature. If the hypothalamus senses that a woman is too warm, it starts a chain of events to cool her down. Blood vessels near the surface of the skin begin to dilate (enlarge), increasing blood flow to the surface in an attempt to dissipate body heat. This produces a red, flushed look to the face and neck in light-skinned women. It may also make a woman perspire to cool the body down. Women may sense their hearts beating faster. A cold chill often follows a hot flash. A few women experience only the chill.

Menopause-related hot flashes usually follow a consistent pattern unique to each woman, but the pattern differs greatly from woman to woman. Some hot flashes are easily tolerated, some can be annoying or embarrassing, and others can be debilitating.

Q. Is menopause the only cause of hot flashes?
A. Other medical conditions such as thyroid disease, infection, or (rarely) cancer can cause hot flashes too. Drug therapies such as tamoxifen for breast cancer, raloxifene for osteoporosis, and some antidepressants produce them as well. Don’t assume that all hot flashes are caused only by menopause. If it’s unlikely that menopause is the cause or if there are other unusual symptoms, consult your healthcare provider.

Q. How long will I have hot flashes?
A. Most women experience hot flashes for 6 months to 2 years, although some reports suggest that they last considerably longer—as long as 10 years, depending on when they began. For a small proportion of women, they may never go away. It is not uncommon for women to experience a recurrence of hot flashes more than 10 years after menopause, even into their 70s or beyond. There is no reliable way of predicting when they will start—or stop.

Q. Are there treatments for hot flashes?
A. Although the available treatments for hot flashes do not cure hot flashes, they do offer relief. Hot flashes usually fade away eventually without treatment, and no treatment is necessary unless hot flashes are bothersome. A few women have an occasional hot flash forever. There are a number of low-risk coping strategies and lifestyle changes that may be helpful for managing hot flashes, but if hot flashes remain very disruptive, prescription drug therapy may be considered. Prescription hormone therapy approved by FDA and by Health Canada—systemic estrogen therapy and estrogen-progestogen therapy for women with a uterus—are the standard treatments. Another FDA-approved hormone product for women with a uterus combines estrogen with the selective estrogen receptor modulator 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.

For women who prefer not to take hormones or cannot take hormones safely, nonhormone 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 FDA has approved thus far for treating hot flashes is paroxetine 7.5 mg. Other antidepressants, certain drugs used to treat high blood pressure, a medication for sleep, and gabapentin, a drug used to treat epilepsy and migraine, have shown some effectiveness.

Q. Is it safe to take dietary supplements or herbal therapies for my menopause symptoms?
A. No over-the-counter (OTC) dietary supplement or herbal therapy has been found to be effective on menopause symptoms. If you still want to try a dietary supplement for your hot flashes, you must continue only with the appropriate oversight of your healthcare provider. Because normal FDA regulations for prescription or OTC drugs do not apply to dietary supplements, demonstrating safety is not required before a dietary supplement is put on the market. Although a number of manufacturers do employ rigorous quality-control measures, many products are not monitored for purity or levels of active ingredients.

In Canada, the term natural health product is used in place of dietary supplement. The 2004 Canadian Natural Health Products Regulations ensure that these products are safe, are of high quality, and actually do what they claim that they do. Canadian regulations require that all natural health products have a product license before they can be sold, and they must be produced at a site that also has a license. Supplements in the United States are not regulated in this fashion, and the buyer should be aware of this lack of regulation. Products are typically not pulled from the market until after people have been harmed.

Dietary supplements or herbal therapies can interact with prescription drugs, resulting in either increased or decreased effects of the drug, the supplement, or both. Until clinical trials provide scientific evidence of the effectiveness and safety of any given supplement, it is always best to speak to your clinician before using any dietary supplements in the United States and to inform your physician if you are already taking them.

Q. How can I find a menopause specialist?
A. The North American Menopause Society maintains a search feature on this website for those women in the United States or Canada who are looking for an expert interested in helping them manage their health through menopause and beyond. Healthcare providers who have passed a competency examination leading to the prestigious credential of NAMS Certified Menopause Practitioner (NCMP) are noted in the displayed results 

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