Hot flashes affect about three fourths of postmenopausal women and are one of the
most common health problems in this demographic group. Dysfunction of central thermoregulatory
centers caused by changes in estrogen levels at the time of menopause has long been
postulated to be the cause of hot flashes. Treatment should begin with a careful patient
history, with specific attention to the frequency and severity of hot flashes and
their effect on the individual's function. For mild symptoms that do not interfere
with sleep or daily function, behavioral changes in conjunction with vitamin E (800
IU/d) use is a reasonable initial approach. For more severe symptoms, the next step
is to determine whether there is a contraindication or a personal reservation to estrogen
replacement therapy. For women who are able and willing to use estrogen, it will successfully
relieve symptoms by about 80% to 90%. In patients with a history of breast or uterine
cancer, treatment with the progestational agent megesterol acetate appears to be a
safe alternative that also decreases hot flashes by approximately 80%. For women unwilling
or unable to use hormone therapy, one of the newer antidepressant agents can be prescribed.
Venlafaxine decreases hot flashes by about 60%. Gabapentin is another drug that appears
promising as therapy for women unable or unwilling to use estrogen, and the results
of ongoing trials to determine its efficacy are eagerly awaited. The use of clonidine,
methyldopa, and belladonna should be discouraged because of their modest efficacy
and adverse effects.
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© 2002 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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- Hot Flashes: The Old and the New, What Is Really True?Mayo Clinic ProceedingsVol. 77Issue 11
- PreviewEstradiol levels decline intermittently during the perimenopausal transition and permanently after menopause. As a consequence, women experience symptoms related to urogenital atrophy, vasomotor instability, neurocognitive dysfunction, accelerated bone loss, and cardiovascular disease. For some women, vasomotor instability and associated insomnia are disabling.
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- CorrectionMayo Clinic ProceedingsVol. 79Issue 8
- PreviewIncorrect information: In the article by Shanafelt et al entitled “Pathophysiology and Treatment of Hot Flashes,” published in the November 2002 issue of the Mayo Clinic Proceedings (Mayo Clin Proc. 2002;77:1207-1218), an incorrect statement was printed in the sixth through ninth lines of the “Neurotransmitters as Effectors of Hot Flashes” section on page 1209, and an incorrect symbol was printed in Figure 1 on page 1209. The sentence should read, “Estrogen withdrawal is associated with decreased blood serotonin levels, whereas estrogen increases serotonin receptors in the hypothalamus.
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