Hot Flashes - What to do?

Women experience hot flashes after menopause. Although many may find resolution after a year or two, some continue to be distressed for many years. 

Initially we treated with a combination estrogen/progesterone pill which simulated the hormonal state before menopause. Unfortunately studies showed this increased the risk of breast cancer and has been mostly abandoned.

In most women the combination is necessary since estrogen alone increases the risk of uterine cancer. If a woman has had a hysterectomy, however, they can take estrogen alone without excess risk of breast cancer. And the reported risks of increased clotting can be avoided by using the estrogen patch. This is what I use for those women.

But is there something for the rest?  Some people have recommended an antidepressant, Effexor (Venlaflaxine) for these symptoms. And it works. In a recent study it was found to be equally effective to estrogen in the prevention of hot flashes. And it has no hormonal effects. I have seen it work in my patients and would use it if needed. This would be an especially useful alternative in women with a history of breast cancer who should not take any hormones under any circumstances.