Hot Flash Treatment – HealthyWomen

What happens to the body during hot flashes?

As you enter perimenopause and menopause, estrogen levels begin to decline. This decrease in estrogen may affect the brain’s thermoregulatory center, which helps regulate body temperature, said Dr. Robin Noble, an obstetrician-gynecologist and chief medical advisor to the nonprofit Let’s Talk Menopause.

Before menopause, your body temperature may change when you rush up stairs or are stressed. But we can embrace it without hot flashes. “As estrogen decreases, your thermoregulatory zone narrows. You have less leeway and are less able to tolerate changes in body temperature,” Noble said.

Hot flashes from menopause can occur anywhere, at any time, day or night, and can range from feeling slightly warm to feeling sweaty and incredibly disruptive. Your skin may feel clammy, and you may feel chills and anxious after the flash.

Hormone therapy for hot flashes

Hormone therapy (HT) is widely considered the gold standard for the treatment of menopause and VMS. HT treats menopause symptoms by replacing estrogen and progesterone in the body.

The two main types of HT are:

• estrogen therapy: This hormone treatment replaces the estrogen your body no longer produces during menopause. Because estrogen treatment itself can increase the risk of uterine cancer, people who no longer have a uterus may be treated with estrogen alone.

• Combination therapy: Combination therapy is a treatment that combines estrogen and progestin. This is recommended for women who still have a uterus. Progestins in combination therapy protect the endometrium from the negative effects of estrogens.

The safest way to receive estrogen therapy is through the skin using patches, gels, mucous membrane rings, or creams. Estrogen pills can also be used, but they increase the risk of stroke slightly. Progestins are often administered orally or vaginally.

Hormone therapy can not only help relieve hot flash symptoms, but it can also protect other parts of the body. HT may help with bone health, cardiovascular disease, diabetes, joint pain, and skin and hair changes. HT also helps regulate mood, so it may help relieve symptoms of anxiety and depression.

However, hormone therapy carries some risks and is not for everyone. If you have had certain types of cancer, are at high risk for blood clots, or have a history of stroke and other cardiovascular disease, you may need to consider other options.

Non-hormonal medications for hot flashes

Some women may not be able to take HT, while others may prefer not to take it. Currently, there are two types of FDA-approved non-hormonal medications on the market that target moderate to severe menopausal hot flashes.

Both non-hormonal drugs work by blocking pathways in the brain’s thermoregulatory center.

• elizanetant (brand name Lynkuet) is a dual NK1 and NK3 receptor antagonist.
• Pezzolinthant (brand name Veozah) is an NK3 receptor antagonist.

Both medications have been shown to reduce moderate to severe menopausal hot flashes and improve sleep quality.

Note: Because elizanetant and fezolinetant are processed by the liver, you should have a blood test every 3 months to check your liver enzymes.

Talk to your doctor about hot flashes

When you’re struggling with hot flashes, it may feel like there’s no end in sight. That’s why it’s important to find a health care provider (HCP) who will listen to your concerns and help you make informed decisions.

Here are some ways to prepare for your appointment:

• Track your symptoms for a few weeks before your appointment.
• Write down your questions so you don’t forget them.
• Share your preference for hormonal or non-hormonal medications.

If your health care provider is dismissing your symptoms or not listening to you, it may be time to seek new health care. To find a menopause-certified provider near you, search The Menopause Society directory by zip code. Or, find a telemedicine expert. With more choices available, there’s no reason for anyone to suffer from hot flashes.