Many women find the hot flashes and night sweats of menopause uncomfortable, but for some women these symptoms are unbearable. The standard treatment is estrogen replacement therapy. While estrogen is effective, the evidence from the Women’s Health Initiative that Premarin and Provera increased the risk for blood clots, heart attacks, strokes and breast cancer greatly reduced the popularity of this treatment.

The National Institutes of Health funded a study called MsFLASH of treatments for the hot flashes and night sweats of menopause. Low-dose estradiol (0.5 mg/day), low-dose venlafaxine (75 mg/day, a starting dose for this antidepressant) and placebo were compared in a randomized controlled trial of more than 300 women. The women kept diaries of their symptoms during the eight weeks of the trial.

At the start of the study, women experienced an average of about 8 hot flashes daily. Both estradiol and venlafaxine reduced the number by about half, which was more than the reduction among women taking placebo. About 70 percent of the women taking estradiol were pleased with their results, compared to roughly half of those on venlafaxine and not quite 40 percent of those on placebo. Side effects included insomnia for those on estradiol and fatigue among those taking venlafaxine. Some women also developed elevated blood pressure.

The investigators concluded that differences in response between the two treatments were minimal, although both were better than placebo. This research offers women a few options for managing menopausal symptoms that they have not had until now. Another antidepressant, paroxetine, originally sold as Paxil, is now available under the brand name Brisdelle to treat moderate to severe hot flashes.

[JAMA Internal Medicine, online May 26, 2014]

Our Guide to Menopause discusses some alternative approaches to quelling hot flashes.


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  1. H.D.

    After never taking any type of hormones, I had a total hysterectomy at the age of 47. That was 16 yrs ago. My dr first put me on Premarin (I didn’t know any better). Within a week, my hubby was ready to kick me out of the house. We read an article about BHRT. We went to the seminar, contacted my dr who agreed to switch me. Within 48 hrs, I was back to ME!! I’ve had differing doses over the years. We’ve tried weening me off them, but my PSVT kicks into gear, so to keep my heart normal, I’ve stayed on them. Yes, I am 63 and still on the tri-est/progesterone BHRT. Love those plant hormones!! It has definitely worked for me.

  2. DS

    Wow. That may have worked for me. I wish I’d known! I never made the connection. I used to be trusting of doctors before I realized they all seem to be “trained” by drug reps. Better Living Through Chemistry. NOT.

  3. Barbara C

    I had tried all of the supplements mentioned as well as the herbals, removing sugar, coffee, chocolate etc. and nothing touched what I was going through. It was more than the sweats and flashes. I contacted an APRN who set me up for blood work to see exactly where I was lacking. From there a prescription was made up (bioidentical hormone replacement BHRT) for me from a compounding pharmacy with estradiol and more set in a cream that I use daily. I found immediate results, within 2-3 days of starting, and it was once again safe for my husband. Poor Guy! We have tweaked the formula over the past few years and I have also attempted to go off it occasionally. I do not know what I would have done without this option.

  4. MB

    It’s funny how so many women have so many different solutions, some diametrically opposed. For one person, eat no meat. For me, cutting phytoestrogens out of my diet (no more beans or peanut butter) worked well. A few days without them, and the hot flashes went from every hour or so to maybe one per week. One nibble of peanut butter, and I’d have another hot flash within 30 minutes to an hour. After 5 or 6 years I could add them back in small amounts, and now (nine years out) I am back to eating lots of p.b., some beans.

  5. DS

    Some women developed high blood pressure…..
    I would bet their doctors treated them for THAT and probably never made the connection. One prescription leads to another.

  6. Amiee L

    I take 540 MG of Black Cohosh daily and it stopped my night sweats. I also gave a bottle to a friend of mine and it stopped her night sweats also. I have not had heat flashes at this point in time.

  7. Marilyn

    Get your vitamin d level checked. Eat a Mediterranean Diet and as little red meat as possible. Supplement with fish oil (if you don’t eat fish), flax seed oil, a good multi vitamin and Holy Basil.

  8. grace

    I take 400mg Vitamin E and 100 mg B6…IT WORKS FOR ME!

  9. Linda

    I am 54 and had terrible hot flashes, night sweats with a lot of anxiety. I started taking Indivina which is Estradiol valerate 1mg and Medroxyprogesterone acetate 2,5mg, one tablet a day and it really helped me. I remember reading that a Swedish study revealed it was safe compared to Premarin. I like the fact that it’s such a small dosage and it really makes a difference. I have taken it a year now. I stopped two months ago to see and had to get back on it.

  10. JAS

    I have a moral issue with Premarin so I don’t take it or anything else for the constant hot flashes. Going cold turkey is just, plain horrible, but I have to follow my own moral compass, but the truth also needs to be said to consumers. Why would I want to even use Premarin when I know it’s been made from “pre”gnant “mare” urine — (hence the label “Pre-marin”)?
    Why would I want to use a product taken from animals that are abused, kept in stalls & forced to stand & not move? Taking away the babies from the moms & keeping the mares continuously pregnant causes the mares extreme stress, which no doubt, causes more stress hormones to be released by the mare which, no doubt, puts negative elements (stress hormones) in the “Premarin” products, which I bet, increases the cancer risk in human menopausal women.
    So (A) I don’t trust the product, since it raises cancer risks; and (B) It’s not a moral product under any circumstances. But hey, what do I know? I’m only a menopausal woman with continuous hot flashes which I can describe as feeling like you’re sick and have a fever. Not fun, but at least I can live with myself. Everyone needs to choose for themselves.

  11. Rosalie W.

    I am well past the pause but what helped me was something I heard about from a naturepath. It was Dong Qui and Black Cohosh. It also helped my nerves. I don’t know how my husband lived with me. Like any herb it has to get into your bloodstream for a few months before you start seeing the benefit.

  12. fbl

    My problem was solved when my Dr. did some testing. My progesterone barely registered when tested and my vitamin D level was incredibly low. After starting on progesterone, vitamin D, NatureThyroid and ioidine I did not have any hot flashes at all.

  13. Barb S.

    Here they go again! Treating menopause with anti-depressants and estrogen!
    There are herbal remedies for hot flashes that are very effective and SAFE and bio-identical progesterone which has been sold over the counter since the late 1930’s and is beneficial in many ways and not harmful in any way. Natural progesterone helps rebuild bone, protects blood vessels from spasms, has a calming effect and promotes better sleep, among others.
    People’s Pharmacy response: The low-dose estrogen tested, 17-beta estradiol, is a “bio-identical” estrogen.

  14. A.P.

    I eliminated all sugar, carbohydrates during my menopause. I felt onstead of hot flashes at age 44, right away did research about healthy diet to minimize the flashes. Sugar was the number one factor. It worked wonders for me.

  15. BLM

    An alternative approach to menopausal symptoms, having nothing to do with pharmaceuticals: swimming. I’ve been a lap swimmer for many years, and didn’t have difficulties with night sweats or hot flashes during menopause. Swimming is a great mood enhancer, too, for those who enjoy the sport. Good luck to all you readers out there, and never-ending thanks to the People’s Pharmacy, for publishing such an extraordinary amount of valuable health information.

  16. Nancy

    Not exactly “new” information – I’ve been on Paxil (or it’s generic alternative – which is another rant) for several years now. Still having hot flashes and night sweats, but they’re at least manageable.

  17. JS

    What brand(s) of the DHEA do you use? Do you experience any side effects from the DHEA?

  18. Linda S.

    I had no desire to use HRT. A friend recommended Capsules of evening primrose oil. After one week, I never had another hot flash. I stayed on them for one year and then passed them along to a coworker as soon as she mentioned her hot flashes.

  19. HJagow

    I researched DHEA extensively and found that half a 25 mg tab daily did away with night sweats and hot flashes almost immediately. My symptoms were pretty severe–up to change a soaked nightgown at night, hair on back of head soaked during day. That was in late 90’s.
    I continue to take that small dose and find that vaginal dryness has not been a problem. I do not understand why this is not better known. I only buy name brand tabs.
    A doctor I went to at the time prescribed Premarin which caused forced periods of black discharge. Tossed both that doc and the med, and my “pause” resumed, but with the hormones provided by the DHEA without discomfort.

  20. Lf

    very surprised you make NO mention of how very addictive the mentioned antidepressants are and the withdrawal effects can be very very difficult…this is now well documented….and there are many websites dedicated to supporting those who have been victims of these very powerful medications….

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