What Doctors Want You to Know About Severe Menopause Hot Flashes

Women can experience menopause in a wide variety of ways, but one of the most common is having hot flashes. About 80 percent of women have hot flashes in some form, but as with other aspects of menopause, those warm spells can be very different from person to person.

“Some women can have lots of hot flashes, but they’re not really bothered by them,” says Stephanie Faubion, MD, medical director of The Menopause Society and director of Mayo Clinic’s women’s health center in Jacksonville, Florida. “But there’s some women that have maybe one or two whoppers a day, and it’s really derailing them. And they’re waking up at night drenched, [having] to get up and change clothes.”

Because women’s experiences with hot flashes can be so wide ranging, you may wonder what constitutes a mild hot flash versus a severe one — and which ones warrant treatment.

“It’s subjective, and it’s the woman that’s going to tell us if [the hot flashes are] bothering her. And I don’t think we need to categorize them. If [the woman is] in our office, they’re bothered,” says Dr. Faubion. “It’s really more about the bother than it is about how many you’re having every day and how ‘severe’ they are. It’s how much it interferes or causes bother.”

If you see a primary care doctor or menopause specialist for hot flashes or other symptoms, there are a few things you can expect at the appointment.

Discussion of Symptoms

“A menopause evaluation usually begins with a detailed conversation,” says Cathleen M. Brown, DO, a board-certified ob-gyn and medical director at Winona who is based in Philadelphia. You’ll talk about your menstrual history, when the hot flashes began, how often you’re experiencing them, and how they’re affecting your sleep, emotional well-being, and daily life.

Your doctor may also use a specific screener, such as The Menopause Society’s health questionnaire, to guide the conversation.

You could also keep a symptom diary, logging hot flashes for a week or two, but all your doctor really needs to know is how much the hot flashes have been bothering you, says Dr. Brown. Your doctor may ask about nighttime awakenings and how they’re affecting your concentration, energy, exercise, social activities, and work, for example.

Health History

Your doctor will also ask about your health history, including any other conditions you may have, previous treatments you’ve tried, medications and supplements you currently take, and family history of disease. This can help them suggest treatments that may be safe and effective for you.

Going Over Options for Treatment

If you seem to be a candidate for hot flash treatment, the doctor will discuss your options.

“By the end of the visit, the patient should understand her treatment options, their potential benefits and risks, and the plan for follow-up,” says Brown.

If you’re regularly experiencing hot flashes — not just occasional, mild spells — and they’re affecting your quality of life, your healthcare provider may recommend different treatments, says 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.

Lifestyle Modifications

• Manage the temperature of your home or office
• Wear cooling clothing
• Avoid hot flash triggers, such as alcohol, caffeine, and spicy food
• Exercise and/or do yoga regularly
• Lose weight
• Practice relaxation techniques

These strategies can be used in conjunction with each other and alongside drug treatments.

Prescription Treatments

• Menopause hormone therapy is considered a first-line treatment for hot flashes. Estrogen is administered via gel, patch, pill, spray, or vaginal ring to help increase the hormone throughout the body and reduce hot flashes.
• Antidepressant medications, such as certain selective serotonin (SSRI) and serotonin–norepinephrine (SNRI) reuptake inhibitors, can help with temperature regulation and have been shown to lessen hot flashes.
• Neurokinin (NK3) receptor antagonists have been developed to reduce hot flashes.
• Gabapentin (Neurontin) is a medication typically prescribed to treat seizures and nerve pain but can be prescribed off label for hot flashes.
• Oxybutynin (Ditropan) is used to treat overactive bladder symptoms but can also be prescribed off label for hot flashes.

“Hormone therapy remains the most effective option,” says Faubion. “But it’s not an option for some women, so we need to discuss all the options that are out there.”

She adds that cognitive behavioral therapy has been shown to be effective as a nonhormonal, nonmedication option.

There are many safe and effective treatments for hot flashes and other menopause symptoms, but many women are still unaware of their options. “A visit with your healthcare provider or a menopause specialist can bring you relief and peace of mind,” says Dr. Dedania. “And it’s well worth the time.”