Management of Hot Flashes and Night Sweats

Treatment Approach

The American College of Physicians recommends non-hormonal treatments as first-line therapy for patients with normal hormone levels experiencing vasomotor symptoms, with lifestyle modifications such as weight loss of ≥10% body weight, smoking cessation, and limited alcohol intake 1
For patients with mild to moderate symptoms, non-pharmacological approaches should be started first, according to the American Heart Association 2
The American College of Obstetricians and Gynecologists suggests that low-dose paroxetine (7.5mg daily) reduces frequency, severity, and nighttime awakenings of hot flashes, and gabapentin 900mg/day decreases hot flash severity by 46% vs 15% with placebo 1
The North American Menopause Society recommends cognitive behavioral therapy (CBT) to reduce perceived burden of hot flashes, and venlafaxine is supported by evidence for severe hot flashes 1, 4

The American College of Cardiology states that estrogen is the most effective treatment for vasomotor symptoms, reducing hot flashes by a mean of two to three per day, and transdermal formulations are preferred due to lower VTE and stroke risk 3, 1
The Endocrine Society advises using the lowest effective dose for the shortest duration possible, and combined estrogen/progestin increases breast cancer risk with use >3-5 years 1

Active liver disease is an absolute contraindication for any menopausal hormone therapy, according to the American Association for the Study of Liver Diseases 1
The robust placebo response in hot flash studies (up to 70%) makes it difficult to establish true treatment efficacy, as noted by the National Institutes of Health 2