Hot flashes

A healthcare professional can most often diagnose hot flashes based on your symptoms. 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 to take estrogen. But taking this hormone carries risks. If estrogen is right for you and you start it within 10 years of your last menstrual period or before age 60, the plusses can be greater than the risks.

Medicines such as 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 likely don't need 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 healthcare professionals prescribe to ease hot flashes. Most people who have had their uteruses removed, called a hysterectomy, can take estrogen alone. But those who still have a uterus most often need to take progesterone with estrogen. This is to protect against cancer of the lining of the uterus, called endometrial cancer.

Guidelines suggest using the smallest dose of estrogens 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.

Like progesterone, taking bazedoxifene with estrogen may keep you from the higher risk of endometrial cancer that you can get from estrogen alone. Bazedoxifene also might protect your bones.

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

Antidepressants

The U.S. Food and Drug Administration approves only one treatment that doesn't use hormones for hot flashes. The treatment is a low-dose form of paroxetine (Brisdelle).

Other antidepressants that have been used to treat hot flashes 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 pill or patch mostly used to treat high blood pressure, might give some relief from hot flashes. Side effects include being dizzy, drowsy and constipated and having a dry mouth.
• Fezolinetant (Veozah). This daily pill treats menopause hot flashes without hormones. It works by blocking a pathway in the brain that helps to manage body temperature.

Side effects include belly pain, diarrhea, trouble sleeping, back pain, hot flashes and higher liver enzymes, which can be a sign of liver damage. Most healthcare professionals don't prescribe this medicine to people with liver disease.

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, you might try lifestyle changes. 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. If you're overweight or obese, losing weight might help ease your hot flashes. The North American Menopause Society says weight loss may improve hot flashes for some women.

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

Studies suggests that certain methods can 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 doctor about any supplements you take.

Dietary supplements people often use for menopause symptoms include:

• Plant estrogens. Some plants have substances that are like the hormone estrogen. 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 ginseng to ease hot flashes.
• Dong quai. Studies have not found dong quai to work for hot flashes. Also, 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'll likely start by seeing your main healthcare professional or a specialist in 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.

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?