2013_Honkamp-Jill_7825-4x5-240x300By Jill Honkamp, MD – Obstetrician/Gynecologist

Picture this – you are in a meeting at work or teaching in front of a classroom of students and it comes on out of the blue. First, your face and chest have a sudden sensation of heat that rapidly spreads to the rest of your body. Next, you perspire profusely, and suddenly the sweater you put on this morning no longer seems like a good idea. This is life with hot flashes.

Hot flashes represent a dysfunction in temperature regulation. The blood vessels beneath the skin dilate and rapidly release heat, resulting in a decrease in core body temperature below normal. Hot flashes can ultimately result in shivering as your body tries to return its temperature to normal. The sensation can last anywhere from two to four minutes and occur at least once or twice a day up to an hourly event. When hot flashes are an hourly event at night, quality of sleep is a thing of the past.

While most hot flashes occur in up to 80 percent of menopausal women, they can also occur in women who are perimenopausal or occasionally in women who are premenopausal. Without treatment, hot flashes eventually resolve in most women within a few years, however almost 10 percent of women over the age of 70 still have hot flashes.

What is a woman to do?

First of all, try to stay cool! Keeping your body cool can help keep hot flashes away. Turn down the thermostat, use a ceiling fan or turn on your air conditioner. Stick to open-neck shirts or dresses. Wear layers so you can easily take something off if you start feeling hot. Also, try sipping on cool beverages like ice water.

Quitting smoking can also relieve hot flashes. Did you know that heavy smoking can cause menopause to start two years earlier compared to nonsmokers? Smokers are more likely to have more frequent and more severe hot flashes. Exercise can also help ease your hot flashes. Women who have a 30-minute moderate-intensity workout experience fewer hot flashes over the following 24 hours!

Pharmaceutical/herbal options

When it comes to medications to treat hot flashes, there are four common options.

  1. There are are over-the-counter herbal remedies. Black cohosh is a popular supplement to treat hot flashes, but evidence regarding effectiveness is mixed. Some studies show a benefit while others show no difference. You can give it a try and if it helps, use if for only as long as you need it. Supplements including dong quai, ginseng, and kava have not been shown to be effective in combating hot flashes. Phytoestrogens and evening primrose oil are no more effective than a placebo.
  2. Another medication option for hot flashes includes prescription nonhormonal medications. Examples of these medications are antidepressants called Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs). Studies show all of these medications were more effective than placebo for decreasing hot flashes. Examples of SSRI include Prozac (fluoxetine), Lexapro (escitalopram) and Paxil (paroxetine). Examples of SNRIs include Effexor (venlafaxine) and Pristiq (desvenlafaxine).  If you are taking tamoxifen for breast cancer, beware that SSRIs and some SNRIs can decrease its effectiveness.  Please talk to your oncologist before starting one of these medications, and talk to your primary care physician before starting any medications. Another prescription nonhormonal medication is Gabapentin. It is also more effective than a placebo for decreasing hot flashes. Taking Gabapentin along with either an SSRI or an SNRI is not more effective than taking either medication alone.
  3. The third option is Clonidine, which has been shown to relieve hot flashes in some but not all clinical trials. It is usually given as a transdermal patch changed every seven days.
  4. The fourth medication option to treat hot flashes is hormone replacement therapy. Hormones can take the form of estrogen, progesterone or a combination of both. Studies have shown these medications are the most effective treatment available for decreasing hot flashes as well as decreasing vaginal dryness. In patients with a uterus who desire hormone replacement therapy (HRT), they must be on progesterone and estrogen in order to decrease the risk of cancer and precancer of the endometrium or lining of the uterus. Most studies suggest the use of HRT for no more than five years or less due to the risks. However, women should be reassured that the absolute risk of complications for healthy, young (age 50 to 59) postmenopausal women who are taking hormone therapy for five years is very low. The primary risks of estrogen and progesterone together include stroke, blood clot and breast cancer.

Don’t suffer in silence. Call us to make an appointment and discuss what we can do to help make menopause much cooler for you!