Hot flashes are sudden sensations of heat that occur in 75-80% of menopausal women in the US, with the median age of menopause being 51 years old. Risk factors include obesity, smoking, low physical activity, and ethnic background. Hot flashes are caused by estrogen withdrawal affecting the hypothalamus and manifest as sudden heat, sweating, and anxiety lasting 2-4 minutes, with frequency ranging from less than one per day to one per hour. Management depends on symptom severity and a woman's medical history, with lifestyle changes for mild cases and hormone therapy or antidepressants for moderate to severe cases. Hormone therapy is generally recommended for symptomatic women within 10 years of menopause who do not have

1. Hot flashes
Gloria Monsalve MD

2. Hot flashes occur in about 75 to 80 percent of menopausal women in the United States.
Median age of menopause in North America is 51 year.
The flashes most often begin in the perimenopausal period, although in some women they do not begin until
after menopause.
Only about 20 to 30 percent of women seek medical attention for treatment.

4. Risk factors
● Obesity Weight loss may help reduce their hot flashes
● Smoking.
● Reduced physical activity.
● Socioeconomic factors.
● Ethnic factors – African-American women report more frequent hot flashes than Caucasian women, and
Japanese and Chinese women less so.

6. Hot flashes are mediated by thermoregulatory dysfunction at the level of the hypothalamus and are induced
by estrogen withdrawal.
“Warmth”

7. CLINICAL MANIFESTATIONS
Sudden sensation of heat centered on the upper chest and face that rapidly becomes generalized.
Lasts from two to four minutes, is often associated with profuse perspiration and occasionally palpitations,
chills, shivering, and a feeling of anxiety.
Less than one each day to as many as one per hour during the day and night.

8. MANAGEMENT
●Symptom intensity and frequency.
●Medical history – Is the patient a candidate for menopausal hormone therapy
●Personal choice – Is the patient interested in MHT?
●Coexistence of other menopausal symptoms, such as depression.

9. 1. Mild hot flashes --->Simple lifestyle changes.
2. Moderate to severe + no risk factors : Low-dose, estrogen plus progestin therapy.
3. Moderate to severe hot flashes in whom estrogen is contraindicated-- >nonhormonal therapies
such as serotonin-norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors
(SSRIs). Paroxetine, citalopram, or escitalopram: first-line drugs.
4. For women with predominantly nighttime symptoms: Gabapentin

10. Choosing candidates for Menopausal Hormone Therapy
WHO?
Symptomatic women who are within 10 years of menopause or younger than age 60 years.
Contraindications to MHT!
-History of breast cancer.
-Coronary heart disease.
-Previous venous thromboembolic event or stroke.
-Active liver disease.

12. Women with a uterus: prescribe combination therapy, using the smallest
effective dosage for the shortest possible duration.
Women with a uterus who are using estrogen should also take a
progestogen to reduce the risk of endometrial cancer.

15. Nonhormonal Therapies for Hot
Flashes in Menopause

19. Final Comment.
Hot flash symptoms can significantly impact a woman’s quality of life and should be addressed.
Severity of the hot flashes, medical history, and concomitant medications should be considered in determining
the best therapy for each patient.
Transdermal 17-beta estradiol for many women starting MHT.
-Since hot flashes gradually subside without therapy in most postmenopausal women, any drug can be
gradually tapered after one to two years of administration.

20. ❖ Nonhormonal Therapies for Hot Flashes in Menopause DANA G. CARROLL, PHARM.D., B.C.P.S., University of
Oklahoma–Tulsa College of Medicine, Tulsa, Oklahoma
❖ Hormone Therapy and Other Treatments for Symptoms of Menopause D. ASHLEY HILL, MD, and MARK
CRIDER, MD, University of Central Florida College of Medicine,
❖ Menopausal hot flashes Authors:Richard J Santen, MDCharles L Loprinzi, MDRobert F Casper, MD
❖ Treatment of menopausal symptoms with hormone therapy Authors:Kathryn A Martin, MDRobert L Barbieri, MD