Hot Flashes

Diagnosis

A healthcare professional can usually diagnose hot flashes based on your symptoms and medical history. In some cases, blood tests may be recommended to check hormone levels and determine whether your menstrual periods are stopping. These tests can also help rule out other possible causes of hot flashes, such as thyroid problems or other hormonal changes.

Treatment

Hot flashes are a common symptom of menopause and can range from mild to severe. The most effective way to relieve hot flashes is through estrogen therapy, though it may not be suitable for everyone. If estrogen isn’t appropriate for you, other medications such as antidepressants or anti-seizure drugs may help. Treatment decisions depend on your age, health history, and how much the hot flashes affect your quality of life.

Hormone therapy

Estrogen is the main hormone used to reduce hot flashes.

• People who have had a hysterectomy can take estrogen alone.

• Those with a uterus usually need a combination of estrogen and progesterone to prevent endometrial cancer.

Medical guidelines recommend using the lowest effective dose of estrogen for the shortest time possible. The duration of treatment depends on how well it works and your overall health risks.

For people who cannot take progesterone by mouth, a combination of bazedoxifene with conjugated estrogens (Duavee) may be prescribed. This combination helps protect against the risk of endometrial cancer and may also benefit bone health.

Individuals with a history or risk of breast or endometrial cancer, heart disease, stroke, or blood clots should discuss alternatives to hormone therapy with their healthcare provider.

Antidepressants

For those who cannot or prefer not to take hormones, certain antidepressants can reduce hot flashes. The only non-hormonal treatment approved by the U.S. Food and Drug Administration (FDA) is low-dose paroxetine (Brisdelle).

Other antidepressants that may help include:

• Venlafaxine (Effexor XR)

• Paroxetine (Paxil)

• Citalopram (Celexa)

• Escitalopram (Lexapro)

While antidepressants are generally less effective than hormone therapy, they can still reduce the frequency and severity of hot flashes. Possible side effects include nausea, trouble sleeping or feeling sleepy, dry mouth, weight gain, and sexual side effects.

Other prescription medicines

Several non-hormonal medicines may help ease hot flashes for some people:

• Gabapentin (Neurontin, Gralise, others): An antiseizure medicine that helps reduce hot flashes. Side effects may include drowsiness, dizziness, fatigue, and swelling in the limbs.

• Pregabalin (Lyrica): Another anti-seizure medicine that may help. Side effects include dizziness, drowsiness, difficulty concentrating, and weight gain.

• Oxybutynin (Oxytrol): Usually used for overactive bladder but may relieve hot flashes. Side effects include dry mouth, constipation, nausea, dizziness, and dry eyes.

• Clonidine (Catapres-TTS 1, Nexiclon XR, others): Commonly used for high blood pressure but may reduce hot flashes. Side effects include dry mouth, constipation, drowsiness, and dizziness.

• Fezolinetant (Veozah): A newer non-hormonal pill that blocks a brain pathway controlling body temperature. It can cause side effects like abdominal pain, diarrhea, insomnia, back pain, and elevated liver enzymes. This medicine is not recommended for those with liver disease.

Nerve block procedure

A treatment called stellate ganglion block may help people with moderate to severe hot flashes. This involves injecting a numbing medicine into a nerve cluster in the neck that influences body temperature regulation. It has been used in pain management, and while early research is promising, more studies are needed. Possible side effects include mild pain or bruising at the injection site.

Hot flashes often lessen over time, even without treatment. However, if they significantly affect your comfort or sleep, talking with your healthcare provider about the best treatment options can help improve your quality of life.