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Treatments and drugs
By Mayo Clinic staffMenopause is a natural transition. If hot flashes don't interfere with your life, you don't need treatment. If it's necessary to ease your symptoms with treatment, periodically re-evaluate your need for continuing that treatment. For most women, hot flashes fade gradually within a few years.
Hormone therapy
For moderate to severe hot flashes, your doctor may recommend hormone therapy. Estrogen therapy is the most effective treatment for hot flashes, but in some instances, doctors might prescribe progesterone therapy instead.
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Estrogen therapy. If you've had a hysterectomy, you can take estrogen alone. But if your reproductive organs are still intact, you should take progesterone along with estrogen to protect against cancer of the lining of the uterus (endometrial cancer). With either regimen, current recommendations are to use the lowest effective dose for the shortest amount of time needed to relieve symptoms.
Before starting estrogen therapy for menopause symptoms, review your heart-disease risk factors with your doctor and weigh the benefits of symptom relief against the risk — remote but recognized — of developing heart disease as a result. It's likely that hormone therapy interacts with other factors — timing and length of hormone use, reproductive history and family history, for example — to increase this risk, but there's no way to know what's safest for you individually. Your doctor can help you weigh the pros and cons.
Estrogen therapy is not a good option if you've ever had a blood clot or breast cancer.
- Progesterone therapy. As an alternative for women who can't take estrogen, some doctors prescribe progesterone alone to control hot flashes. Two progesterone-like drugs, megestrol acetate and medroxyprogesterone acetate, have been found to provide some relief from hot flashes.
Other prescription medications
If you decide against estrogen or progesterone therapy, your doctor may suggest a nonhormonal medication for reducing hot flashes. These medications aren't approved by the Food and Drug Administration specifically to treat hot flashes, but they are approved for treating other conditions.
- Antidepressants. Low doses of certain antidepressants may decrease hot flashes. Antidepressants from classes of medications known as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) — including venlafaxine (Effexor), paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa), desvenlafaxine (Pristiq) and others — have been found to relieve hot flashes. However, these medications aren't as effective as hormone therapy for severe hot flashes and may cause unwanted side effects, such as nausea, dizziness, weight gain or sexual dysfunction. Talk with your doctor about whether the benefits outweigh the potential side effects for you.
- Gabapentin. Gabapentin (Neurontin) is a medication approved for treating seizures or pain associated with shingles. It's also increasingly used to treat various other types of pain. Gabapentin may be moderately effective in reducing hot flashes, particularly for women who have symptoms at night. Side effects can include drowsiness, dizziness and headaches.
- Clonidine. Clonidine, a pill or patch typically used to treat high blood pressure, may provide some relief from hot flashes. Side effects such as dizziness, drowsiness, dry mouth and constipation are common, sometimes limiting the medication's usefulness for treating hot flashes.
- Casper RF, et al. Menopausal hot flashes. http://www.uptodate.com/home/index.html. Accessed April 22, 2009.
- Schorge JO, et al. The mature woman. In: Schorge JO, et al. Williams Gynecology. New York, N.Y.: McGraw-Hill; 2008. http://www.accessmedicine.com/content.aspx?aID=3158924. Accessed April 21, 2009.
- Menopause: Medicines to help you. U.S. Food and Drug Administration: Office of Women's Health. http://www.fda.gov/womens/medicinecharts/menopause.html. Accessed April 22, 2009.
- Nathan L, et al. Menopause and postmenopause. In: DeCherney AH, et al. Current Diagnosis and Treatment Obstetrics & Gynecology. 10th ed. New York, N.Y.: McGraw-Hill; 2002. http://www.accessmedicine.com/content.aspx?aID=2393309. Accessed April 21, 2007.
- Manson JE, et al. Estrogen therapy and coronary-artery calcification. The New England Journal of Medicine. 2007;356:2591.
- Herbal products for menopause. American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp158.cfm. Accessed April 22, 2009.
