The most effective treatment for hot flashes is estrogen, but taking this hormone can increase your risk of developing other health problems. Medications such as antidepressants and anti-seizure drugs also may help reduce hot flashes.
Discuss the pros and cons of various treatments with your doctor. If hot flashes don't interfere with your life, you may not need treatment. For most women, hot flashes fade gradually within a few years.
Estrogen and progesterone are the hormones used to reduce hot flashes. Women who have had a hysterectomy can take estrogen alone. But if you still have a uterus, you should take progesterone along with estrogen to protect against cancer of the lining of the uterus (endometrial cancer).
With either regimen, current recommendations from the American College of Obstetricians and Gynecologists are to use the lowest effective dose for the shortest amount of time needed to relieve symptoms.
A combination drug of bazedoxifene with conjugated estrogens (Duavee) has been approved for treatment of menopausal symptoms. This drug may avoid the increased risk of cancer, but more study is needed.
Estrogen therapy is not a good option if you've ever had a blood clot or breast cancer.
Low doses of certain antidepressants may decrease hot flashes. Examples include:
- Venlafaxine (Effexor XR, Pristiq)
- Paroxetine (Brisdelle, Paxil, Pexeva)
- Fluoxetine (Prozac, Sarafem)
Brisdelle is the only antidepressant medication approved by the Food and Drug Administration for treating hot flashes. But, it's expensive compared with generic formulations. The other drugs and formulations are prescribed off-label.
Antidepressants aren't as effective as hormone therapy for severe hot flashes, but they can be helpful to women who can't or don't want to use hormones. Possible side effects include headache, fatigue, nausea, dizziness, weight gain, dry mouth, sexual dysfunction, suicidality and a withdrawal syndrome if the medicines are abruptly stopped. Some side effects may decrease over time or with an adjustment to the dose. If you have suicidal thoughts while taking one of these medications, seek medical help immediately.
Other prescription medications
Other medications that may offer relief for some women include:
Oct. 02, 2015
- Gabapentin (Neurontin, Gralise). Gabapentin is an anti-seizure medication that's moderately effective in reducing hot flashes. Side effects can include drowsiness, dizziness and headaches.
- Clonidine (Catapres, Kapvay, others). Clonidine, a pill or patch typically used to treat high blood pressure, may provide some relief from hot flashes. Side effects include dizziness, drowsiness, dry mouth and constipation.
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Gynecology. ACOG Practice Bulletin No. 141: Management of menopausal symptoms. Obstetrics & Gynecology. 2014;123:202.
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- Frequently asked questions. Women's health FAQ047. Menopause. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq047.pdf?dmc=1&ts=20140312T1457400846. Accessed March 12, 2014.
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- AskMayoExpert. Hot flash management using alternatives to estrogen. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
- Pachman DR, et al. Management of menopause-associated vasomotor symptoms: Current treatment options, challenges and future directions. International Journal of Women's Health. 2010;2:123.
- FDA approves the first non-hormonal treatment for hot flashes associated with menopause. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm359030.htm. Accessed Sept. 23, 2015.
- Brisdelle medication guide. U.S. Food and Drug Administration. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM362200.pdf. Accessed Sept. 23, 2015.
- Rohren CH (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 22, 2015.