Hot Flashes Treatment: Managing Vasomotor Symptoms

Hot flashes affect 75% of menopausal women, ranging from mild warmth to drenching sweats that disrupt daily life. Modern treatment offers various effective options beyond simply enduring symptoms.

Understanding Hot Flashes

The Physiology

Hot flashes result from thermoregulatory dysfunction. Declining oestrogen affects the hypothalamic thermostat, narrowing the thermoneutral zone. Minor temperature changes trigger inappropriate heat loss responses:

• Peripheral vasodilation

• Sweating

• Increased heart rate

• Skin flushing

Episodes typically last 1-5 minutes but can persist longer.

Patterns and Triggers

Hot flash patterns vary individually:

• Frequency: Several daily to occasional

• Severity: Mild warmth to drenching sweats

• Timing: Random or predictable

• Duration: Months to years

Common triggers include:

• Stress and anxiety

• Caffeine and alcohol

• Spicy foods

• Warm environments

• Tight clothing

Identifying personal triggers enables avoidance strategies.

First-Line Treatment: HRT

Oestrogen Therapy Efficacy

HRT remains the most effective hot flash treatment, reducing frequency by 75% and severity significantly. Benefits typically appear within 4 weeks, with maximum effect by 3 months.

Systemic oestrogen addresses the underlying cause rather than just managing symptoms. All delivery methods - oral, transdermal, vaginal ring - effectively treat hot flashes.

Dosing Strategies

Start with lowest effective dose:

• Begin conservatively

• Titrate based on response

• Individual variation significant

• Higher doses for severe symptoms

• Reduce once controlled

Some women need higher doses initially, reducing after symptom control.

Progesterone Considerations

Progesterone alone can reduce hot flashes:

• Micronised progesterone 200-300mg

• Medroxyprogesterone acetate 20mg

• Particularly useful if oestrogen contraindicated

Some women find progesterone improves sleep beyond hot flash reduction.

Non-Hormonal Medications

SSRIs and SNRIs

Antidepressants effectively reduce hot flashes:

Venlafaxine: 37.5-75mg daily reduces hot flashes by 60%. Start low, increase gradually. Side effects include nausea and dizziness.

Paroxetine: 7.5mg (specific low-dose formulation) FDA-approved for hot flashes. Avoid with tamoxifen due to interaction.

Escitalopram: 10-20mg daily shows good efficacy with favourable side effect profile.

Desvenlafaxine: 50-100mg daily, well-tolerated option.

Other Medications

Gabapentin: 300mg three times daily particularly helps night sweats. Start with evening dose, titrate slowly. Drowsiness common initially.

Clonidine: 50-75mcg twice daily provides modest benefit. Side effects include dry mouth, dizziness, constipation.

Oxybutynin: 5mg twice daily, traditionally for overactive bladder, shows promise for hot flashes.

Fezolinetant: New neurokinin-3 antagonist specifically for vasomotor symptoms. 45mg daily significantly reduces hot flashes.

Lifestyle Modifications

Environmental Management

Simple changes reduce symptom impact:

• Layer clothing for easy adjustment

• Keep bedroom cool (18°C)

• Use moisture-wicking bedding

• Portable fans for quick relief

• Cold water and cooling wipes accessible

These strategies provide immediate relief during episodes.

Weight Management

Higher BMI correlates with worse hot flashes:

• Even modest weight loss helps

• Improves overall health

• Enhances treatment effectiveness

• Reduces cardiovascular risk

Sustainable approaches work better than extreme dieting.

Exercise Benefits

Regular physical activity paradoxically reduces hot flashes despite raising body temperature:

• Aerobic exercise most beneficial

• Yoga shows specific benefits

• Improved temperature regulation

• Better stress management

• Enhanced sleep quality

Start gradually, building intensity slowly.

Complementary Approaches

Cognitive Behavioural Therapy

CBT specifically for hot flashes includes:

• Paced breathing during episodes

• Cognitive restructuring

• Stress management techniques

• Behavioural modifications

Group or self-help formats available. Reduces bother more than frequency.

Acupuncture

Evidence suggests modest benefits:

• Traditional or electroacupuncture

• Weekly sessions initially

• Maintenance treatments monthly

• Placebo effect significant

• Safe when properly performed

Consider qualified practitioners only.

Herbal Remedies

Limited evidence supports:

• Black cohosh: Mixed results

• Red clover: Contains isoflavones

• Evening primrose oil: Minimal evidence

• Sage: Traditional use

Quality and standardisation vary significantly.

Dietary Interventions

Phytoestrogens

Plant oestrogens may help:

• Soy products (tofu, tempeh)

• Flaxseeds

• Chickpeas and lentils

• Whole grains

Regular consumption more effective than supplements.

Trigger Avoidance

Dietary modifications reduce episodes:

• Limit caffeine

• Reduce alcohol

• Avoid spicy foods

• Stay hydrated

• Regular meal patterns

Individual triggers vary - keep symptom diary.

Combination Strategies

Stepped Approach

Progressive treatment intensification:

1. Lifestyle modifications

2. Add complementary therapies

3. Consider medications

4. Combine approaches

Many women need multiple strategies.

Personalised Plans

Treatment selection considers:

• Symptom severity

• Medical history

• Personal preferences

• Contraindications

• Quality of life impact

Regular review ensures optimal management.

Struggling with hot flashes? Book your online GP consultation via WhatsApp for personalised treatment planning combining evidence-based options for effective symptom control.