Actually, there is no reason to “treat” hot flashes unless they are affecting your quality of life.
Systemic estrogen therapy is the therapeutic standard for treating moderate to severe menopause-related hot flashes. If you have a uterus, you should use a combination of estrogen and the sister hormone progesterone. We titrate the dose of estrogen up until the hot flashes and night flushes are tolerable or gone.
However, taking systemic estrogen therapy is not a quick decision. As with any prescription drug, there are risks associated with taking it. Your physician can give you enough estrogen to stop your hot flashes if you are able and willing to take the risk.
But for some patients that can’t or won’t take estrogen, there are some solutions. There are some anti-depressants that have been used very successfully to treat hot flashes. There have been some studies that have verified this. In 2014, the first anti-depressant, paroxetine, was approved by the FDA for hot flashes. It is a low-dose of this anti-depressant and seems to be just enough to help women tolerate this symptom.
The off-label (not FDA-approved) use of gabapentin (also known as Neurontin), pregabalin (lyrica), clonidine, Bellergal, and methyldopa (Aldomet) have been used alone or in combination to treat hot flashes. They have been successful in many patients.
Over time, most physicians will temporarily stop the treatment to see if the hot flashes have gone away. You shouldn’t think that you will need treatment forever, as the hot flashes tend to go away over time.
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