190124 Nonhormonal medications to treat hot flashes 2/3

If lifestyle changes are not enough to improve your symptoms, nonhormone options for managing hot flashes may work for you. These may be a good choice if you are unable to take hormones for health reasons or if you are worried about the potential risks.

The U.S. Food and Drug Administration (FDA) has approved the use of paroxetine, a selective serotonin reuptake inhibitor (SSRI) antidepressant, to treat hot flashes. Researchers are studying other antidepressants, which doctors may prescribe for off-label use.

Women who use an antidepressant to help manage hot flashes generally take a lower dose than people who use the medication to treat depression. As with any medication, talk with your doctor about whether this is the right medication for you and how you might manage any possible side effects.

Buyer beware: Unproven, nonscientific ‘treatments’ for hot flashes

You may have heard about black cohosh, DHEA, or soy isoflavones to treat hot flashes. These products are not proven to be effective, and some carry risks such as liver damage.

Phytoestrogens are estrogen-like substances found in some cereals, vegetables, and legumes (like soy), and herbs. They may work in the body like a weak form of estrogen, but they have not been consistently shown to be effective in research studies, and their long-term safety is unclear.

Always talk with your doctor before taking any herb or supplement. Currently, it is unknown whether these herbs or other “natural” products are helpful or safe to treat your hot flashes or other menopausal symptoms. The benefits and risks are still being studied.

Using hormones to treat hot flashes and night sweats

Some women may choose to take hormones to treat their hot flashes or night sweats. A hormone is a chemical substance made by an organ like the thyroid gland or ovary. During the menopausal transition, the ovaries begin to work less effectively, and the production of hormones like estrogen and progesterone declines over time. It is believed that such changes cause hot flashes and other menopausal symptoms.

Hormone therapy steadies the levels of estrogen and progesterone in the body. It is a very effective treatment for hot flashes in women who are able to use it. They can also help with vaginal dryness, sleep, and maintaining bone density.

Hormone treatments (sometimes called menopausal hormone therapy, or MHT) can take the form of pills, patches, rings, implants, gels, or creams. Patches, which stick to the skin, may be best for women with cardiac risk factors, such as a family history of heart disease.

There are risks associated with taking hormones, including increased risk of heart attack, stroke, blood clots, breast cancer, gallbladder disease, and dementia. Women are encouraged to discuss the risks with their health care provider. The risks vary by a woman’s age and whether she has had a hysterectomy. Women who still have a uterus would take estrogen combined with progesterone or another therapy to protect the uterus. Progesterone is added to estrogen to protect the uterus against cancer, but it also seems to increase the risk of blood clots and stroke.