Medications for hot flashes

There are several medication options to treat hot flashes. All options come with their own risks and benefits. Talk to your doctor about these risks, benefits, and side effects before you start any medication.

Hormones

A number of prescription medications are available to treat hot flashes. Hot flashes are linked to decreased levels of estrogen. Estrogens given in pill, patch, or gel form can help relieve this symptom. The following products are available in Canada:

• estrogen pills: estradiol-17β (Estrace®), estropipate (Ogen®), conjugated estrogens (Premarin®, CES®, Congest®, generics), esterified estrogens (Estragyn®)
• estrogen patches: estradiol-17β (Climara®, Estraderm®, Estradot®, Sandoz® estradiol derm), estradiol hemihydrate (Oesclim®)
• estrogen gel: estradiol-17β (Estrogel®)

Estrogen pills and gel are used once daily. They may be used every day, on days 1 to 25 of each month, or on days 1 to 21 of a 28-day cycle. The patches are used once or twice weekly. Estrogens may affect or be affected by medications for diabetes, epilepsy, high blood pressure, and blood clots.

Women who have not had a hysterectomy will need to take a progestin while taking estrogen pills, patches, or gel to protect them from endometrial hyperplasia or cancer. The progestin is either given continuously (every day) or cyclically (for 10 to 14 days of each month). Progestins are available alone:

• medroxyprogesterone acetate (Provera®, generics)
• progesterone (Prometrium®)

Progestins are also available in estrogen-progestin combination products, such as:

• estradiol-17β and norethindrone acetate patches (Estalis®)
• estradiol-17β and levonorgestrel patches (Climara Pro®)
• ethinyl estradiol and norethindrone acetate pills (femHRT®)
• conjugated estrogens and medroxyprogesterone acetate pills (Premplus®)
• estradiol hemihydrate and norethindrone acetate pills (Activelle®, Activelle LD®)
• estradiol-17β and drospirenone pills (Angeliq®)

Side effects of estrogen patches and pills may include breast tenderness, nausea, headache, bloating, or irritation in the area where the patch was applied (patches only). Side effects of progestins may include mood changes, bloating, and breast tenderness. Women who use estrogen products should do a breast self-exam (BSE) each month. If you're not sure how to do a BSE, ask your doctor to teach you.

To learn more about the risks and benefits of estrogen and progestin treatment, also called hormone therapy (HT) or hormone replacement therapy (HRT), talk to your health care provider.

Clonidine

During a hot flash, the blood vessels expand, leading to a feeling of warmth or flushing. Clonidine (Dixarit®, generics) works by making the blood vessels less likely to expand or contract.

Clonidine is not a hormone. It is available as pills that are taken twice daily. Although most side effects are mild and diminish with time, clonidine may cause dizziness, low blood pressure, dry mouth, drowsiness, and constipation. It may affect or be affected by medications for high blood pressure.

Belladonna - ergotamine - phenobarbital

This medication is combination of belladonna, ergotamine, and phenobarbital (Bellergal® Spacetabs); it is not a hormone. It contains 3 active ingredients, which work by relieving anxiety and counteracting the expansion of the blood vessels that's associated with hot flashes. It is available as tablets that are taken twice daily, and may cause dry mouth, constipation, and drowsiness. It may affect or be affected by HIV medications, certain migraine medications, and certain anti-infective medications.

It's best to talk to your doctor regularly about how you're feeling to determine if you need to continue to take medications. Don't stop treatment on your own.

Alternative and herbal medications

Non-prescription and herbal options for hot flashes and related symptoms (such as sweating and sleep difficulties) include:

• black cohosh: a herbal medication that has often been recommended for mild hot flashes and related symptoms. There have been reports of liver problems in people taking black cohosh.
   
• valerian: a herbal medication that may help with sleep problems by causing drowsiness. There have been reports of visual hallucinations, nightmares, and changes in normal thinking in people taking valerian. Do not take valerian with alcohol or sedatives, as this combination can cause increased drowsiness.

As with other medications, there are side effects and risk associated with taking herbal and non-prescription medications. Do not start using a herbal or non-prescription medication without talking to your doctor or pharmacist, especially if you are taking other medications or have other medical conditions.