Taking the Edge off Severe Hot Flashes

Q:  I am 51 years old and recently began menopause. I am very symptomatic - I'm having hot flashes that keep me up at night, interrupt my ability to concentrate at work, and cause me embarrassment.

I have a sister with breast cancer, so I do not want to go on hormone therapy. What are the other options?

A:  Symptoms such as hot flashes, insomnia, irritability, and difficulty concentrating are very common in women going through menopause. For some, they present minimal burden on daily activities, but for others, as in your case, they can affect quality of life. Many women think there is something wrong with them when they experience menopausal symptoms. These symptoms, though, are a normal part of aging.

There are many options to treat hot flashes that affect quality of life. Behavioral changes, naturopathic treatments, and prescription medications may all play a role in treatment.

First, I recommend dressing in layers, using a desk fan, and exercising as simple behavioral modifications to reduce menopausal symptoms.

Naturopathic treatments, such as soy and other foods containing plant estrogens, and herbal medications like black cohosh, have shown minimal, if any benefit in the treatment of hot flashes. Many women like to try them, though, because of the allure of naturopathic medicines. The jury is still out as to whether these natural remedies are safe, especially in breast cancer survivors.

Prescription-strength medications to treat menopausal symptoms include hormones, antidepressants, clonidine, and gabapentin. I will not discuss hormones in depth given your family history of breast cancer; however, they remain a very good option for most women who are symptomatic.

Other prescription treatments include using medications from the antidepressant class. I have had excellent success in treating patients with Effexor, an antidepressant that seems to reduce the severity of the hot flashes. Clonidine is a blood pressure medication that also reduces hot flashes. I use it mainly in patients who have mild hypertension and menopausal symptoms to treat both problems.

Finally, gabapentin has a role again in reducing hot flashes, especially those that are worse at night. It is used most commonly before bedtime to aid in sleep and also to reduce the severity and frequency of nocturnal hot flashes. It can also be used throughout the day, but many women find that sedation is a problem and prefer to use it mainly at night.

Whatever treatment you and your doctor decide to use, I would recommend trying it for 1-2 years and then re-evaluating your symptoms, as most women's menopausal symptoms last less than five years.

Deidre L. Faust, MD, is a Staff Physician (Internal Medicine) at the Medical College of Wisconsin's Plank Road Clinic. Her column appears in the Milwaukee Journal-Sentinel.