When Lifestyle Changes Aren’t Enough: Treatments for Severe Menopause Hot Flashes

In some cases, these sudden bouts of heat are manageable with simple lifestyle strategies. Being in cool environments and wearing cooling clothing, exercising regularly, and doing yoga can all help manage hot flashes, says Sherry Ross, MD, a board certified obstetrician-gynecologist (ob-gyn) at Providence Saint John’s Health Center in Santa Monica, California. “Also, avoiding triggers like spicy food, alcohol, and caffeine can be successful ways to minimize mild-to-moderate hot flashes.”

But in other cases, hot flashes are less manageable and can negatively affect work, sleep, sex, relationships, exercise, and overall quality of life. “Hot flashes are also associated with an increased risk of heart disease, diabetes, sleep dysfunction, bone loss, depression, anxiety, dementia, and Alzheimer’s disease,” she says.

If hot flashes are interfering with your everyday life, you may need to work with your doctor to explore treatment options beyond lifestyle changes.

You’re the best judge of whether lifestyle changes are working well enough to relieve hot flashes. There’s no set number of hot flashes per day, week, or month that warrants treatment for everyone. It’s about how disruptive they are to you personally.

According to Sheetal Dedania, MD, an ob-gyn and physician manager at Reiter, Hill & Johnson of Advantia in Chevy Chase, Maryland, and a Menopause Society certified practitioner, some signs that hot flashes may need more than self-care include:

• Decreased focus on work or other tasks
• Depression and other mood changes
• Fatigue
• Interrupted or poor sleep
• Irritability
• Relationship and/or confidence issues

Also, keep in mind that while hot flashes are a common menopause symptom, other conditions can cause them, as well. Keep an eye out for any other symptoms not typically associated with menopause.

“If you’re experiencing night sweats or hot flashes with sudden, unexplained weight loss, a chronic cough, or swelling in lymph nodes, this is a reason to see your healthcare provider,” says Dr. Dedania. “Lymphoma or tuberculosis can share those symptoms.”

There’s a variety of treatment options for menopause hot flashes. These are a few common ones your healthcare provider may discuss with you:

Hormone Therapy

“Hormone therapy is most effective in treating disruptive hot flashes affecting a woman’s quality of life,” says Dr. Ross. “[It] increases the body’s estrogen levels, which nicely treats hot flashes and night sweats.”

NK3 Receptor Antagonists

Off-Label Treatments

Gabapentin (Neurontin), a medication typically used to treat nerve pain and seizures, and clonidine (Catapres, Kapvay), a blood pressure medication, have been prescribed off label to women with hot flashes. “[These drugs] help minimize hot flashes by working with the body’s central nervous system, stabilizing the temperature center in the hypothalamus,” says Ross.

Antidepressant Medications

Another option could be antidepressants. As with clonidine, “SSRI [selective serotonin reuptake inhibitor] and SNRI [serotonin–norepinephrine reuptake inhibitor] antidepressants help with hot flashes by controlling neurotransmitters in the temperature center in the hypothalamus,” says Ross.

Nondrug Options

Open communication with your healthcare provider can help ensure they understand your symptoms, medical history, and goals. “You need to play an active role in making treatment decisions,” says Ross. This could mean keeping a symptom journal and preparing key questions for your visit.

Stephanie Faubion, MD, medical director of The Menopause Society and director of Mayo Clinic’s women’s health center in Jacksonville, Florida, says that a primary care physician or ob-gyn should be equipped to provide the menopause care you deserve. But if you’re not getting the answers or relief you need, you can always seek a menopause specialist on The Menopause Society’s practitioner directory.

If you decide to try treatment for hot flashes, you’ll need to use it for a little while — exactly how long will depend on the treatment. Dr. Faubion recommends giving treatment about two months to see if it’s helping. “However, if you have a side effect or, for example, you broke out in a rash with the patch, that would require changing it before two months,” she says.

Be sure to check in with your doctor for follow-ups, and let them know if the treatment isn’t working well, you’re experiencing side effects, or anything else changes.