Women experiencing hot flashes should notify their physician. To determine whether hot flashes are caused by menopause, the physician will perform a physical examination and compile a medical history of the patient. The physician may also perform a number of tests that may help reveal whether menopause has occurred. An individual can have certain hormones (FSH and LH) measured by a blood test. These hormones are associated with causing the release of estrogen and progesterone. When FSH and LH become elevated, it indicates that estrogen levels are low.

The Food and Drug Administration (FDA) states that women who have hot flashes less than seven times per day have “mild” symptoms, which may not require treatment. However, only an individual patient can determine if the frequency and intensity of hot flashes require treatment.

For women who are experiencing hot flashes as part of menopause, it is important to note that menopause is a natural part of aging and thus it is perfectly normal to elect no treatment at all for the hot flashes. In fact, the National Institutes of Health (NIH) has called for the “demedicalization” of menopause and its symptoms, including hot flashes. The NIH states that menopause is not a disease that always requires “treatment” since many women make the transition with few disabling symptoms and even moderate symptoms may not require medical intervention.

Although hot flashes are a normal part of perimenopause and menopause, severe or frequent hot flashes that disrupt a woman’s daily life or cause sleep disorders may require treatment. Before considering medical treatment, a woman may want to start by making healthy lifestyle choices as they can make a significant difference in the frequency and severity of hot flashes. These include quitting smoking, eating a well-balanced diet and getting regular exercise.

However, if these steps do not work, there are other steps to reduce the severity of symptoms, especially hot flashes, which are associated with this time of life. The most common form of treatment for hot flashes is hormone replacement therapy (HRT). This involves taking synthetic estrogen alone or a combination of estrogen and synthetic progesterone, known as progestin. HRT is associated with certain risks including blood clots, stroke, heart attacks, breast cancer and Alzheimer’s disease, and some women will be poor candidates for HRT. Therefore, women should consult with their physician prior to taking HRT.

Women who experience hot flashes during perimenopause (and who do not smoke) may want to consider low-dose oral contraceptives (birth control pills) since these can help control hot flashes and regulate the menstrual cycle. However, women who smoke, have a history of blood clots or breast cancer should not take birth control pills. This topic should be discussed with a physician.

In some cases, alternative medications can be taken to help reduce hot flashes, including short term, low dose estrogen, certain antidepressants (selective serotonin reuptake inhibitors [SSRIs]), blood pressure medications and the anticonvulsant gabapentin. However, a recent review of various studies found that non-hormonal therapies (e.g., SSRIs, blood pressure drugs, gabapentin) are less effective than estrogen therapy for alleviating hot flashes and often have side effects including nausea, dizziness, drowsiness, sexual dysfunction, imbalance when walking, leg swelling, dry mouth and constipation.

Some women may turn to herbal or dietary supplements (e.g., black cohosh, soy products) for alleviating their hot flashes and night sweats. However, a large year-long clinical trial funded by the NIH and published in late 2006 found black cohosh (whether used alone or with other herbal supplements) not effective for relieving hot flashes in postmenopausal women or those approaching menopause. Other forms of complementary and alternative medicine, such as acupuncture and massage therapy, may help induce relaxation, which in turn, may provide some relief for women who experience hot flashes. Although these are not considered medications, their use should be discussed with a physician.

In addition, an expert panel on menopause from the NIH cautioned women to be wary of studies with limited safety data. They concluded that to date, nothing has been proven to be as effective as estrogen therapy for alleviating hot flashes and additional research is needed.