Ask Dr. K: An alternative treatment for hot flashes

For years, women took hormone replacement therapy (HRT) to ease hot flashes and other symptoms of menopause. Indeed, many women continued to take HRT after the hot flashes had gone, in order to achieve improved heart health. Then, studies showed that long-term use of HRT in women older than their late 50s (or more than 10 years out from menopause) actually increased the risk of heart disease.

That study (published in 2002) led many doctors to stop prescribing HRT short-term — even just to relieve hot flashes. In my judgment, that was a mistake. In fact, I prescribe HRT in women experiencing hot flashes, except in unusual situations. I have discussed the reasons in a previous column: The 2002 study primarily included women at least 10 years past menopause, not women in menopause, like you.

However, you asked about treatments for hot flashes other than HRT. One effective alternative may be antidepressant drugs. That is not because hot flashes are caused by depression. The antidepressant drugs change brain chemistry, and the changes they cause seem also to reduce hot flashes.

Escitalopram (Lexapro), for example, is a selective serotonin reuptake inhibitor (SSRI) antidepressant. It reduces the frequency, severity and discomfort of hot flashes, compared to a placebo (dummy pill).

Researchers at Harvard-affiliated Massachusetts General Hospital looked at the antidepressant duloxetine (Cymbalta). This is a different type of antidepressant. Depressed women treated with duloxetine found that their menopausal symptoms, including hot flashes, improved.

An antiseizure drug, gabapentin (Neurontin), may also reduce hot flashes.

Several over-the-counter herbal remedies also claim to prevent or treat hot flashes. Black cohosh is one example. But many of these herbal treatments have not been well studied.

In the last couple of years, women’s health experts have started to rethink the role of HRT. They still discourage it as a long-term treatment. But they are starting to reconsider it for short-term use, to relieve temporary symptoms (including hot flashes) that do not respond to other therapies.

Finally, don’t forget to try simple, non-drug strategies. They can cool you down without any side effects:

— Turn the thermostat down.

— Keep bedding light.

— Dress in layers, so you can adjust your clothing when a hot flash comes on.

— Limit caffeine, which can worsen hot flashes.

— Carry a small, clip-on fan with you.

I would recommend that you try these non-pharmaceutical remedies first, and go on to pharmaceuticals only if they don’t give you sufficient relief.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.