Hot flashes can be treated with medicine and simple steps

Q: I'm afraid to take hormone therapy for my menopausal hot flashes. Are there any natural remedies that work?

A: Natural remedies can help for hot flashes, but hormone therapy is helpful more often. For that reason, I'll come back to the pluses and minuses of hormone therapy after answering your question.

Obviously, you know what hot flashes are like. However, for any readers who may not, here's a description: Hot flashes are brief but intensely uncomfortable feelings of warmth followed by drenching perspiration.

They're common during menopause, but not all women get them.

Hot flashes can be accompanied by heart palpitations, dizziness or weakness. They can cause sleepless nights, followed by irritability and exhaustion during the day. At their worst, they can really interfere with a woman's life.

There are traditional medicines other than hormone therapy that can help with hot flashes. Several drugs that usually are used to treat depression give relief of symptoms for some women.

These drugs include paroxetine (approved by the Food and Drug Administration to treat menopausal symptoms), venlafaxine, desvenlafaxine, citalopram and escitalopram.

The fact that these drugs can be helpful does not mean that hot flashes are a sign of depression. Instead, the drugs likely alter the brain chemistry that generates hot flashes.

Three other traditional medicines that also affect the chemistry of the brain can give symptom relief. These include gabapentin, pregabalin and clonidine.

Several nonmedicinal treatments (such as isoflavones, phytoestrogens and black cohosh) may help, although different studies have come to different conclusions. The same is true for acupuncture and hypnosis.

You can take steps to help make hot flashes less severe or less frequent - steps that don't require either traditional medicines or "natural remedies." Here are some suggestions:

• Drink a glass of cool water at the beginning of a hot flash.

• Drink six to eight glasses of water per day.

• Plunge your hands in cold water and pat them on your face, neck and chest when a hot flash starts.

• Avoid caffeine and alcohol, which make hot flashes more uncomfortable.

• Cut down on red wine, chocolate and aged cheeses. They contain a chemical that can trigger hot flashes.

• Don't smoke. Smoking can make hot flashes worse.

• Wear loose, comfortable cotton clothing.

• Dress in layers, so that you can easily remove some clothing if you suddenly feel hot.

• At night, use lightweight blankets that can be removed.

Now, let's come back to hormone therapy. Here's the bottom line - at least for me - of a complicated story. The most effective medication for hot flashes is the hormone estrogen. If you are entering menopause - which typically occurs in a woman's late 40s or early 50s - consider hormone therapy.

The exceptions: Avoid hormone therapy if you have (or are at high risk for) heart disease, stroke, breast cancer, liver disease or blood clots in the legs.

• Dr. Komaroff is a physician and professor at Harvard Medical School. For questions, go to AskDoctorK.com.