Hot flashes

A healthcare professional can often diagnose hot flashes based on symptoms alone. You might have blood tests to see whether your periods are stopping or to find other causes of your hot flashes.

The best way to relieve hot flashes is with estrogen therapy. But using this hormone for treatment of menopause symptoms carries risks. If you start estrogen therapy within 10 years of your last menstrual period or before age 60, the benefits may be greater than the risks.

Antidepressants and anti-seizure medicines also might help ease hot flashes. But they don't work as well as hormones do.

Talk to your healthcare professional about the pros and cons of treatments for hot flashes. If hot flashes don't bother you much, you may not need any treatment. For most people, hot flashes go away slowly, even without treatment. But it can take several years for them to stop.

Hormone therapy

Estrogen is the main hormone used for treating hot flashes. If you have had your uterus removed, called a hysterectomy, you can take estrogen all by itself. But if you still have a uterus, you may need to take progesterone along with estrogen. This is to protect you from developing a certain type of cancer in the lining of the uterus, called endometrial cancer.

Guidelines suggest using the smallest dose of estrogen that manages symptoms. How long you use the treatment depends on how well hormone therapy works for you and your risks. The goal is to give you the best quality of life.

Some people who take progesterone with estrogen therapy have side effects from the progesterone. For people who can't take progesterone by mouth, a mixed medicine of bazedoxifene with conjugated estrogens (Duavee) also can treat menopausal symptoms. Bazedoxifene also might help protect your bones.

If you have had or are at risk of breast cancer or endometrial cancer, heart disease, stroke or blood clots, talk with your healthcare professional about whether estrogen therapy is safe for you.

Antidepressants

Some treatments that don't use hormones are approved by the U.S. Food and Drug Administration has approved for hot flashes. One of these is a low-dose form of the antidepressant paroxetine (Brisdelle).

Other antidepressants have been used to treat hot flashes, but they are not approved by the FDA for this use. These include:

• Venlafaxine (Effexor XR).
• Paroxetine (Paxil).
• Citalopram (Celexa).
• Escitalopram (Lexapro).

Antidepressants don't work as well as hormone therapy for strong hot flashes. But they can help people who can't use hormones. Possible side effects include nausea, trouble sleeping or feeling sleepy, weight gain, dry mouth or trouble having sex.

Other prescription medicines

Other medicines that might offer relief for some people include:

• Gabapentin (Neurontin, Gralise, others). This antiseizure medicine helps ease hot flashes. Side effects can include being drowsy, dizzy or tired and swelling in the arms and legs, called edema.
• Pregabalin (Lyrica). This is another anti-seizure medicine that can help ease hot flashes. Side effects can include being drowsy and dizzy, having trouble focusing, and gaining weight.
• Oxybutynin (Oxytrol). This is a pill or patch most often used to treat urinary conditions like overactive bladder. It also may help ease hot flashes in some people. Side effects can include dry mouth, dry eyes, having nausea, and being constipated and dizzy.
• Clonidine (Catapres-TTS-1, Nexiclon XR, others). This is a pill or patch mostly used to treat high blood pressure. It might give some relief from hot flashes. Side effects include being dizzy, drowsy and constipated and having a dry mouth.
• Fezolinetant (Veozah) or elinzanetant (Lynkuet). These medicines are free of hormones. Both are FDA approved for treating menopause hot flashes. The medicines work by blocking one or more pathways in the brain that help manage body temperature. Early studies suggest they also may help improve sleep. Fezolinetant can cause abdominal pain, diarrhea and liver problems. Elinzanetant may cause headaches, diarrhea, nausea and drowsiness. Side effects usually get better after the first few weeks of taking either medicine. You may need to have testing done to check liver enzymes before starting these medicines and again in a few months.

Nerve block procedure

A procedure called a stellate ganglion block has shown promise for treating moderate to strong hot flashes. It involves shooting a numbing medicine into a nerve cluster in the neck.

Healthcare professionals have used the treatment for pain management. Side effects include pain and bruising at the site of the shot. More research is needed.

If your hot flashes are mild, lifestyle changes might help. The North American Menopause Society no longer suggests most of these because there aren't enough studies to show that they work. But they also are not harmful.

You might try the following:

• Keep cool. Body temperature that goes up a little can cause hot flashes. Dress in layers so that you can remove clothing when you feel warm. Open windows or use a fan or air conditioner. Lower the room temperature, if you can. If you feel a hot flash coming on, sip a cold drink.
• Watch what you eat and drink. Hot and spicy foods and drinks with caffeine and alcohol can cause hot flashes.
• Practice mind-body therapies. Some people get relief from mild hot flashes through meditation; slow, deep breathing; stress management techniques and guided imagery. Even if these approaches don't help your hot flashes, they might do some good, such as helping you sleep better.
• Don't smoke. Smoking is linked to more hot flashes. By not smoking, you might ease hot flashes. You also may lower your risk of serious health conditions, such as heart disease, stroke and cancer.
• Lose weight. The North American Menopause Society says weight loss in people who have overweight or obesity may improve hot flashes.

Many people use alternative medicine to help ease hot flashes. But there are few well-designed studies on complementary health practices for hot flashes.

Mind and body approaches

Some studies suggest that mind and body approaches may help ease hot flashes, including:

• Cognitive behavioral therapy, also called CBT. The North American Menopause Society suggests that this type of counseling works for easing how much hot flashes and night sweats bother you.
• Hypnosis. The North American Menopause Society suggests hypnosis for treating hot flashes. Research shows that hypnosis might help both how often you get hot flashes and how bad they are.
• Mindfulness meditation. This type of meditation has you focus on the moment. There's little proof that mindfulness eases hot flashes. But mindfulness might ease how much hot flashes bother you.
• Acupuncture. Some studies show that acupuncture might lessen how often you get hot flashes and how bad they are. Other studies show that acupuncture doesn't help hot flashes.

Dietary supplements

People think of dietary supplements as natural and causing no harm. But all supplements may have side effects that can be harmful. And supplements also can affect medicines you take for other medical conditions. Talk with your healthcare professional about any supplements you take.

Dietary supplements some people try for menopause symptoms include:

• Plant estrogens. Some plants have substances that are like the hormone estrogen that the body produces. Examples are soy, red clover and flaxseed. But studies most often have found that plant estrogens help menopause symptoms little or not at all. Research is ongoing.
• Black cohosh. Many people use black cohosh to ease menopause symptoms. Studies of how well black cohosh works have had mixed results. And it's rare, but there may be a link between black cohosh and liver damage.
• Ginseng. Studies have not found evidence that ginseng eases hot flashes. 
• Dong quai. Studies have not found dong quai to work for hot flashes. Taking dong quai with blood-thinning medicines may cause bleeding problems.
• Vitamin E. Taking a vitamin E supplement might ease mild hot flashes. In high doses, it can raise the risk of bleeding.

For hot flashes, you may see your main healthcare professional or a doctor who specializes in treating conditions of the female reproductive system, called a gynecologist.

What you can do

Before your appointment, make a list of:

• Your symptoms, including how many hot flashes you have a day and how bad they are.
• Medicines, herbs, vitamins and supplements you take, including the doses. A dose is how much you take.
• Questions to ask your healthcare professional.

Some basic questions to ask include:

• Do I need any tests?
• What treatments can help with my symptoms?
• What else can I do to ease my symptoms?
• Do you have printed information I can have? What websites do you suggest??

Be sure to ask all the questions you have. Bring something along, such as notebook or digital device, where you can record information you get during your appointment.

What to expect from your doctor

Your healthcare professional might ask the following:

• Are you still having periods?
• When was your last period?
• How often do your symptoms bother you?
• How much do your symptoms bother you?
• Does anything seem to help?
• Does anything make your symptoms worse?