What Can I Do About Hot Flashes?

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Q. My doctor doesn’t want to prescribe hormone replacement therapy, but my hot flashes and insomnia are destroying my daily life. What can I do to get some relief?

A. The first line of defense against menopausal symptoms is keeping a healthy diet, exercising and avoiding hot-flash triggers such as alcohol and caffeine. But for many women it’s not enough to sit near a fan eating soy.

“For women who do not get relief from lifestyle measures, a retreat from all therapy does not make sense,” says Dr. Nanette Santoro of the Albert Einstein College of Medicine in the Bronx, N.Y. “Quality-of-life studies indicate that women who do get relief are better off with the therapy. And for about 85 percent of women, this is going to be short-term treatment.”

Hormone replacement therapy (or HRT) treats menopausal symptoms by replenishing estrogen and/or progesterone, which the body stops producing in menopause. Studies show a small degree of risk relating to breast cancer, cardiovascular disease, stroke and blood clots. Establish whether your doctor is drawing a hard line against the therapy or if your personal medical history puts you at higher risk.

Low doses of SSRIs, the serotonin uptake inhibitors used to treat depression, are a fast-acting, non-hormonal alternative. Dr. Santoro notes, “The way these drugs work in low doses is distinct from how they treat depression. As anyone who’s ever had a hot flash can tell you, it’s not psychiatric.”

More Questions & Answers

Dr. Nanette Santoro
Professor and Director, Reproductive Endocrinology
Albert Einstein College of Medicine (Bronx, N.Y.)

Rich Maloof lives in Brooklyn, New York. He specializes in health topics, music and children’s literature. He has written for CNN, Yahoo!, Billboard and the “For Dummies” book series.