“As many as 75% of perimenopausal women in North America experience hot flashes, and for a quarter of these women, hot flashes are so disturbing that they seek help”.1

Umbrella
What may the Hot Flushes Treatment Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Complementary and Integrative Health
  • Hormone Replacement Therapy
  • Hormone Therapy
  • Hot Flashes/Flushes Treatment/s
  • NonHormonal Prescriptions
  • Selective Serotonin Reuptake Inhibitors

Cure or Not

Does hot flushes treatment cure hot flushes?

In Menopause FAQs: Hot Flashes – Q. Are there treatments for hot flashes? the North American Menopause Society (NAMS) elaborate on:

Hot Flushes Treatment
“A. Although the available treatments for hot flashes do not cure hot flashes, they do offer relief. Hot flashes usually fade away eventually without treatment, and no treatment is necessary unless hot flashes are bothersome. A few women have an occasional hot flash forever. There are a number of low-risk coping strategies and lifestyle changes that may be helpful for managing hot flashes, but if hot flashes remain very disruptive, prescription drug therapy may be considered”.2

Hormone Therapy

Is menopausal hormone therapy (MHT) an effective hot flushes treatment?

One of the International Menopause Society’s (IMS) governing principles in the 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT published online 12 February 2016, is:

  • “MHT remains the most effective therapy for vasomotor symptoms and urogenital atrophy”.3

What are vasomotor symptoms?

The IMS explain:

“Hot flushes and night sweats are also referred to as Vasomotor Symptoms (VMS)”.4

What is urogenital atrophy?

Urogenital atrophy, atrophic vaginitis or the genito-urinary syndrome of menopause may include changes to a woman’s urinary system and vagina, such as vaginal atrophy and vaginal dryness.

What do the NAMS note about HT?

The NAMS note:

“Prescription hormone therapy approved by the US Food and Drug Administration (FDA) and by Health Canada—systemic estrogen therapy and estrogen-progestogen therapy for women with a uterus—are the standard treatments”.5

Uterus

Hot Flushes TreatmentWhat HT may women who have a uterus be prescribed for hot flushes treatment?

In Menopause FAQs: Hormone Therapy for Menopause Symptoms – Q. What is hormone therapy? the NAMS elaborate on:

“A. …Women who still have a uterus need to take a progestogen in addition to estrogen or the estrogen-SERM combination to protect against uterine cancer”.6

What is another FDA-approved HT women who have a uterus may be prescribed for hot flushes treatment?

In Menopause FAQs: Hot Flashes – Q. Are there treatments for hot flashes? according to the NAMS:

“A. …Another FDA-approved hormone product for women with a uterus combines estrogen with the selective estrogen receptor modulator (SERM) 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”.7

No Uterus

Hot Flushes TreatmentWhat HT may women who do not have a uterus be prescribed for hot flushes treatment?

In Menopause FAQs: Hormone Therapy for Menopause Symptoms – Q. What is hormone therapy? the NAMS elaborate on:

“A. …Women who have had a hysterectomy (had their uterus removed) can use estrogen alone to control their hot flashes”.8

Hormone Therapy Alternatives

Are HT alternatives available for hot flushes treatment?

In NonHormonal Treatments for Menopausal Symptoms the Australasian Menopause Society elaborate on:

“Many women request non-hormonal treatments for menopausal symptoms”.9

The (Australian) Jean Hailes for Women’s Health (JH) note:

  • “If you cannot take MHT, other medications such as antidepressants – selective serotonin (SSRIs) or norepinephrine reuptake inhibitors (SNRIs) – and a chronic pain medicine can reduce hot flushes”.10

The JH also explain:

“A group of antidepressants called SSRIs/SNRIs (selective serotonin or serotonin-norepinephrine reuptake inhibitors – for example, venlafaxine, paroxetine, escitalopram and fluoxetine) have been studied and found to relieve hot flushes. If these medications are going to be effective in reducing hot flushes, they will do so quite quickly. Like all medications, these can have side effects, some examples being nausea, dry mouth and/or insomnia. Paradoxically, sometimes these medications can cause sweats. In breast cancer survivors on tamoxifen, paroxetine and fluoxetine should not be taken as they can reduce the effectiveness of the tamoxifen”.11

In Hot Flashes: Diagnosis & Treatment – Treatments: Antidepressants the (United States) Mayo Clinic elaborate on:

“A low-dose form of paroxetine (Brisdelle) is the only nonhormone treatment for hot flashes approved by the U.S. Food and Drug Administration. Other antidepressants that have been used to treat hot flashes include:

  • Venlafaxine (Effexor XR, Pristiq)
  • Paroxetine (Paxil, Pexeva)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)”.12

The Mayo Clinic also note:

“These medications aren’t as effective as hormone therapy for severe hot flashes, but they can be helpful to women who can’t use hormones. Possible side effects include nausea, difficulty sleeping or drowsiness, weight gain, dry mouth or sexual dysfunction”.13

One of the points of consensus about in the Revised Global Consensus Statement on Menopausal Hormone Therapy – endorsed by seven menopause-related organizations – published online 20 June 2016, is:

  • “If MHT is contraindicated or not desired for treatment of VMS, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors such as paroxetine, escitalopram, venlafaxine and desvenlafaxine, which have been shown to be effective in randomized controlled trials (RCTs), may be considered. Gabapentin may also be considered”.14

Complementary and Integrative Health

What may be the elephant in the room with choosing to use complementary and integrative health for hot flushes treatment?Hot Flushes Treatment

In Hot Flash Relief Without Hormones the author explains:

“There is no question that hormone therapy is the most effective treatment for bothersome hot flashes, but in many cases, hormone therapy is not appropriate, and some women simply choose not to try it. In fact, from 50% to 80% of perimenopausal women try nonhormonal therapies for hot flashes, but without any real guidance on what works (and what doesn’t), woman experiment with different products, often delaying their chance at finding effective treatment, wasting capital, or they suffer in silence”.15

In 4 Things To Know About Menopausal Symptoms and Complementary Health Practices. 2 the (United States) National Center for Complementary and Integrative Health (NCCIH) elaborate on:

“Many natural products, such as black cohosh, soy isoflavone supplements, and DHEA, have been studied for their effects on menopausal symptoms, but scientists have found little evidence that they are helpful. There is also no conclusive evidence that the herbs red clover, kava, or dong quai reduce hot flashes”.16

In Hot Flashes: Diagnosis & Treatment – Treatment: Alternative Medicine the Mayo Clinic elaborate on:

“Many women have turned to alternative medicine, including mind and body techniques and dietary supplements to help curb hot flashes. There’s a shortage of well-designed studies on complementary health practices for hot flashes, but research is progressing”.17

In Menopause: Diagnosis and Management – Information for the Public: Managing Your Symptoms – Hot Flushes and Night Sweats the (British) National Institute for Health and Care Excellence’s (NICE) elaborate on:

“Some women find that the dietary supplements black cohosh and isoflavones can reduce their hot flushes and night sweats. However, the ingredients of these products may vary and their safety is unknown. They may also interfere with any other medicines you are taking”.18

St John’s Wort

Can St John’s wort used for hot flushes treatment?

In Menopause: Diagnosis and Management – Information for the Public: Treating Menopausal Symptoms – Non-Prescribed Treatments: St John’s Wort the NICE explain:

“Some women have found St John’s wort can reduce their hot flushes and night sweats during menopause. However, the ingredients of products containing St John’s wort may vary and their effects are uncertain. Also, these products can interfere with other drugs, including those used to treat breast cancer (for example, tamoxifen)”.19

Other Options

What are other options for hot flushes treatment?

The IMS note:

“Recent work has shown that psychological interventions, using such methods as paced breathing (a slow deep breathing technique), muscle relaxation and biofeedback have proven useful in improving VMS symptoms. Acupuncture has shown some promise in VMS treatment, but this needs to be confirmed by good quality clinical trials”.20

Health Care Provider

What if I would like help with my hot flushes treatment?

If you would like help with your hot flushes, it may be in your best interest to choose to talk to your health care provider about this. In Hot Flash Relief Without Hormones the author elaborates on:

“As many as 75% of perimenopausal women in North America experience hot flashes, and for a quarter of these women, hot flashes are so disturbing that they seek help”.21

The Mayo Clinic also note:

“If hot flashes affect your daily activities or nighttime sleep, consider seeing your doctor to discuss treatment options”.22

In Hot Flashes: What Can I Do? Treating Menopause Symptoms – What’s Right for Me? the (United States) National Institute on Aging elaborate on:

“Deciding whether and how to treat the symptoms of the menopausal transition can be complicated and personal. Discuss your symptoms, family and medical history, and preferences with your doctor. No matter what you decide, see your doctor every year to talk about your treatment plan and discuss any changes you want to make”.23

In 4 Things To Know About Menopausal Symptoms and Complementary Health Practices. 4 the NCCIH remind us:

“Tell all your health care providers about any complementary health practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care”.24

Health Topics A-Z

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Links

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Sources

Where may I find the Sources quoted?

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Sources

  1. Utian, W. Hot Flash Relief Without Hormones. 24 September 2015. North American Menopause Society https://www.menopause.org/for-women/menopause-take-time-to-think-about-it/consumers/2015/10/12/more-women-are-seeking-and-receiving-compounded-hormones Accessed: 24 April 2020
  2. Menopause FAQs: Hot Flashes – Q. Are there treatments for hot flashes? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hot-flashes Accessed: 24 April 2020
  3. Baber, R. J., Panay N. and Fenton, A., the IMS Writing Group (2016). 2016 IMS Recommendations on Women’s Midlife Health and Menopause Hormone Therapy: IMS Governing Principles on MHT. Climacteric 19:2, 110 https://www.imsociety.org/manage/images/pdf/4429e3dd302aac259ad68c3be7f60599.pdf Accessed: 24 April 2020
  4. Hot Flushes and Night Sweats – Background Information: What Are Hot Flushes and Night Sweats? October 2011:1. International Menopause Society https://www.imsociety.org/downloads/world_menopause_day_2011/wmd_media_backgrounder.pdf Accessed: 24 April 2020
  5. Menopause FAQs: Hot Flashes – Q. Are there treatments for hot flashes? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hot-flashes Accessed: 24 April 2020
  6. Menopause FAQs: Hormone Therapy for Menopause Symptoms – Q. What is hormone therapy? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hormone-therapy-for-menopause-symptoms Accessed: 24 April 2020
  7. Menopause FAQs: Hot Flashes – Q. Are there treatments for hot flashes? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hot-flashes Accessed: 24 April 2020
  8. Menopause FAQs: Hormone Therapy for Menopause Symptoms – Q. What is hormone therapy? North American Menopause Society https://www.menopause.org/for-women/menopause-faqs-hormone-therapy-for-menopause-symptoms Accessed: 24 April 2020
  9. NonHormonal Treatments for Menopausal Symptoms. Content Updated September 2018. Australasian Menopause Society https://www.menopause.org.au/hp/information-sheets/600-nonhormonal-treatments-for-menopausal-symptoms Accessed: 24 April 2020
  10. Menopause: What Can You Do To Help With Menopause? Updated September 2018:2. Jean Hailes https://jeanhailes.org.au/contents/documents/Resources/Fact_sheets/Menopause.pdf Accessed: 24 April 2020
  11. Menopause Management: Non-Hormonal Prescription Medications: Antidepressants. Last Updated: 07 April 2020 | Last Reviewed: 17 October 2017. Jean Hailes https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 24 April 2020
  12. Hot Flashes: Diagnosis & Treatment – Treatment: Antidepressants. 24 April 2020. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 07 May 2020
  13. Hot Flashes: Diagnosis & Treatment – Treatment: Antidepressants. 24 April 2020. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 07 April 2020
  14. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:313 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 24 April 2020
  15. Utian, W. Hot Flash Relief Without Hormones. 24 September 2015. North American Menopause Society https://www.menopause.org/for-women/menopause-take-time-to-think-about-it/consumers/2015/10/12/more-women-are-seeking-and-receiving-compounded-hormones Accessed: 24 April 2020
  16. 4 Things To Know About Menopausal Symptoms and Complementary Health Practices. 2. National Center for Complementary and Integrative Health https://nccam.nih.gov/health/tips/menopause Accessed: 24 April 2020
  17. Hot Flashes: Diagnosis & Treatment – Treatment: Alternative Medicine. 24 April 2020. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/diagnosis-treatment/drc-20352795 Accessed: 07 May 2020
  18. Menopause: Diagnosis and Management – Information for the Public: Managing Your Symptoms – Hot Flushes and Night Sweats. Published Date: 12 November 2015. Last Updated: 09 December 2019. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng23/ifp/chapter/Managing-your-symptoms Accessed: 24 April 2020
  19. Menopause: Diagnosis and Management – Information for the Public: Treating Menopausal Symptoms – Non-Prescribed Treatments: St John’s Wort. Published Date: 12 November 2015. Last Updated: 05 December 2019. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng23/ifp/chapter/Treating-menopausal-symptoms Accessed: 24 April 2020
  20. Hot Flushes and Night Sweats – Background Information: What Else Can Be Done? October 2011:2. International Menopause Society https://www.imsociety.org/downloads/world_menopause_day_2011/wmd_media_backgrounder.pdf Accessed: 24 April 2020
  21. Utian, W. Hot Flash Relief Without Hormones. 24 September 2015. North American Menopause Society https://www.menopause.org/for-women/menopause-take-time-to-think-about-it/consumers/2015/10/12/more-women-are-seeking-and-receiving-compounded-hormones Accessed: 24 April 2020
  22. Hot Flashes: Symptoms & Causes – Symptoms and Causes: Symptoms – When To See A Doctor. 24 April 2020. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/hot-flashes/symptoms-causes/syc-20352790 Accessed: 24 April 2020
  23. Hot Flashes: What Can I Do? Treating Menopause Symptoms: What’s Right for Me? Content Reviewed: 26 June 2017. National Institute on Aging https://www.nia.nih.gov/health/hot-flashes-what-can-i-do Accessed: 24 April 2020
  24. 4 Things To Know About Menopausal Symptoms and Complementary Health Practices. National Center for Complementary and Integrative Health https://www.nccih.nih.gov/health/tips/things-to-know-about-menopausal-symptoms-and-complementary-health-practices Accessed: 24 April 2020
Topic Last Updated: 21 May 2020 – Topic Last Reviewed: 24 April 2020
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