Management of Hot Flashes in Post-Menopausal Women

Initial Evaluation

The American College of Obstetricians and Gynecologists recommends assessing frequency, severity, and impact of hot flashes on quality of life in post-menopausal women 1
The National Comprehensive Cancer Network suggests ruling out other causes of vasomotor symptoms, such as thyroid dysfunction and medication side effects, in post-menopausal women 2
For women with vaginal dryness, the National Comprehensive Cancer Network recommends performing a pelvic evaluation to assess for vaginal atrophy 2

The National Comprehensive Cancer Network recommends lifestyle modifications, including weight loss of ≥10% of body weight, which can eliminate hot flash symptoms in post-menopausal women 4, 5
Smoking cessation is recommended by the National Comprehensive Cancer Network as it improves frequency and severity of hot flashes in post-menopausal women 5, 1
The National Comprehensive Cancer Network suggests limiting alcohol intake if it triggers hot flashes in post-menopausal women 5
Physical activity is recommended by the National Comprehensive Cancer Network for overall health benefits, though evidence for direct impact on hot flashes is limited in post-menopausal women 4
The National Comprehensive Cancer Network recommends low-dose paroxetine (7.5mg daily) as a non-hormonal pharmacologic option, which reduces frequency, severity, and nighttime awakenings in post-menopausal women 2, 1
Gabapentin 900mg/day can decrease hot flash severity by 46% vs 15% with placebo, according to the National Comprehensive Cancer Network, and is particularly useful at bedtime for sleep-disturbing hot flashes 2, 1
The National Comprehensive Cancer Network suggests cognitive behavioral therapy (CBT) as a non-hormonal approach, which reduces perceived burden of hot flashes in post-menopausal women 5, 1

The American College of Obstetricians and Gynecologists recommends using the lowest effective dose of estrogen therapy for the shortest duration possible due to associated risks in post-menopausal women 1
The National Comprehensive Cancer Network suggests that transdermal formulations are preferred due to lower VTE and stroke risk in post-menopausal women 1

The American College of Obstetricians and Gynecologists recommends assessing the risk of combined estrogen/progestin therapy, which increases the risk of breast cancer with use >3-5 years in post-menopausal women 1
Active liver disease is an absolute contraindication for menopausal hormone therapy, according to the American College of Obstetricians and Gynecologists 1

The National Comprehensive Cancer Network recommends avoiding hormonal therapy and using non-hormonal options in breast cancer survivors 4, 3
Data from retrospective studies suggest that menopausal hormone therapy may be safe in early-stage endometrial cancer survivors, according to the National Comprehensive Cancer Network 4, 5