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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. 

  • FDA approves first nonhormonal hot flash treatment

    by Margery Gass | Jul 03, 2013
    Good news for women who have been waiting for an effective nonhormonal treatment for hot flashes: the FDA has just approved the very first nonhormonal therapy in the history of menopause. We have known for awhile that some antidepressants provide relief from hot flashes, but not one was officially approved for that purpose. The newly approved product will be a lower dose of an antidepressant first approved 20 years ago (paroxetine, brand name Paxil). The lower dose approved for hot flashes is called Brisdelle and will probably be available in November. Women who have not found sufficient relief for their moderate or severe hot flashes from lifestyle measures will now have one more option to discuss with their healthcare provider.

    Until now, hormone therapy was the only FDA-approved treatment for moderate to severe hot flashes. Some women cannot use hormone therapy for medical reasons or simply prefer not to use it. Brisdelle provides another choice. Although it may not reduce hot flashes as effectively as hormone therapy, it will decrease flashes for most women. Like other drugs, it will not meet the needs of every woman.

    Every drug comes with risks and side effects: In clinical trials studying how the drug affected menopausal women, side effects included headache, fatigue, and nausea/vomiting, most commonly occurring in the first week. The label also carries the warning of all antidepressants in this class, that of potentially increasing suicidal thoughts or behavior in the first few months. There is also a possible reduction in the effectiveness of the breast cancer drug tamoxifen if the drugs are used together.

  • Hot flashes and night sweats before menopause

    by Margery Gass | Jun 17, 2013
    Hear “hot flash” and most of us think of menopause. But reproductive-aged women have them too. How many healthy premenopausal women have vasomotor symptoms (hot flashes and night sweats), and why?

    In women ages 45 to 56 with regular menstrual cycles, about 55% have experienced vasomotor symptoms at some point, shows new research in Menopause. The cross-sectional study examined 1,513 women in the Pacific Northwest. Native American women were most likely to report vasomotor symptoms (66.7%), followed by black women (61.4%), and white women (58.3%).  Asian and Hispanic women in the study were least likely to report ever having vasomotor symptoms (about 8% and 37%, respectively), similar to the patterns during the menopausal transition and early postmenopause.

    Why would premenopausal women have hot flashes? As levels of estrogen go down in the body, numbers of hot flashes go up. Estrogen naturally declines as a woman gets older, especially at menopause. But estrogen levels can fluctuate enough to cause hot flashes years before menopause. Some women have hot flashes right after giving birth. Some may get them from intense exercise or from illness.

    The relationship between reproductive status, general health, hormone levels, age, and vasomotor symptoms is complex and needs further investigation. But rest assured that it is perfectly normal to have hot flashes in the years before menopause. If you are still having regular cycles, these vasomotor symptoms do not necessarily mean menopause is beginning.

    1 Comment
  • What causes hot flashes?

    by Margery Gass | Jan 10, 2013
    Researchers have made new discoveries about how hot flashes happen:

    A group of brain cells called KNDy (“candy”) neurons are probably the control switch for hot flashes. KNDy neurons respond to estrogen. When estrogen gets too low, these brain cells make more of a brain chemical (neurotransmitter) that signals the body that it is too hot. The body then releases heat by opening blood vessels to the skin that cause flushing and sweating as a cooling method.

    Hot flash sufferers, take note: these insights will eventually help scientists create new and safer treatments for menopausal hot flashes. And that’s cool news.

    Go comment!
  • The power of suggestion: hypnotize your hot flashes

    by Margery Gass | Oct 26, 2012
    A new study about the effect of hypnosis on hot flashes published in the NAMS journal Menopause shows that hypnosis can help cut hot flashes by as much as 74%. One group of women in the study got five weekly sessions of hypnosis where they received hypnotic suggestions for mental images of coolness, a safe place, or relaxation — whatever their preference — and they also got a recording to practice with daily. Their hot flashes were reduced by 74% and their severity was also lessened. 

    Another group of women in this study had five sessions with a clinician where they could talk about their symptoms, and they got a CD to listen to daily that had general information about hot flashes. This group reported only a small reduction in hot flashes: 13%.

    This study is the best one so far to test the value of hypnosis for hot flashes because it pitted hypnosis against a similar “treatment” thought not to have much effect, similar to the way drugs are tested against dummy placebo pills. We hope to see these results confirmed by other researchers.
    1 Comment
  • Daily breather may help calm hot flashes

    by Margery Gass | Oct 15, 2012
    Regular, daily practice of calm or slow breathing is key for this alternative technique to ease hot flashes, shows a new paced breathing study in the NAMS journal Menopause. Women in this study practiced breathing rhythmically, either at a normal pace or slowly, for at least 10 to 15 minutes every day. All of them had fewer and less severe hot flashes, but the ones who had the most relief practiced twice a day.

    Both of these approaches are like meditation, which is known to calm down the autonomic nervous system. That’s the system that controls body functions such as sweating, heart rate, and dilation of blood vessels, which all ramp up during a hot flash. You can try the approach that worked best in this study—breathing slowly and regularly at six breaths a minute for 15 minutes twice a day. These short sessions shouldn’t be too hard to work into your busy day.
    Go comment!
  • Chill out: tips to treat your hot flashes

    by Margery Gass | Sep 13, 2012
    Keeping your body cool can help keep hot flashes at bay. Here are just some of the cool tricks:
    • Keep ice water handy to sip.
    • Turn down the thermostat.
    • Use a ceiling fan or air conditioning.
    • Dress cool—wear cotton, linen, or rayon, and avoid wool, other synthetic fabrics, and silk.
    • Stick to open-necked shirts.
    • Dress in layers so you can take something off if you’re feeling warm.
    • At night, take a cool shower before bed, wear cotton nightclothes or loose fitness clothing designed to wick away moisture, and keep an ice pack under your pillow.
    • Get a bigger bed if you and your partner are on different “heat planets.”
    Go comment!

MenoPause Blog

We strive to bring you the most recent and interesting information about various aspect of menopause and midlife health. We accept no advertising for our website. We want you to have accurate, unbiased, evidence-based information. 

JoAnn V. Pinkerton, MD, NCMP
Executive Director



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