Rx meds for hot flashes

September 15, 2022 4:09 AM

I've been having hot flashes on and off for a few years, sometimes manageable with behavioral strategies, and sometimes -- like lately -- not. I've read up a little on HRT, gabapentin, and SSRIs, but each has drawbacks that might be deal-killers. I'd love to hear about some real-life experiences.

HRT -- What's it like being on HRT? What format of it are you on? Having read up at NAMS and elsewhere, I'm comfortable with the risk profile, but not sure about side effects. Back when I was on the pill, it killed my libido dead. If you had that experience too, is it the same with HRT? If you've been on both the pill and HRT, how does it compare in general?

Gabapentin -- If I went with gabapentin, it would just be at night. But other things that cause most people a little drowsiness (e.g., melatonin and zyrtec, the one-and-only time I took each) knock me out hard all through the next day. If you take gabapentin at night, does it let you sleep through night sweats without making you drowsy when it's time to get up? Does it seem like the same quality of sleep as unmedicated, uninterrupted sleep? I've read it can increase appetite and cause weight gain. Does that apply even if a low dose is taken just at bedtime?

SSRIs -- I'm leaning against an SSRI (though I do have some curiosity about their mental health benefits, if those would even come into play at the low doses used for hot flashes). My hot flashes come and go, and it's my impression that it wouldn't be easy to get off SSRIs long enough to find out if I still need them.

I've had weeks or months at a time when my hot flashes are bad, and then they go away completely, and then they come back mild, and then bad again... So it seems like I should pick something I can go on and off repeatedly. Lately, I've been woken up several times every night, and I really need some good sleep. I'm not sure whether to lean towards just addressing that (probably via nighttime-only gabapentin). Or whether to address my hot flashes round-the-clock even though my daytime ones are pretty manageable at the moment. I'd love your thoughts and experiences, plus any other sites where you recommend I read up or ask this question.

(P.S. If this question is relevant to you, so might be two non-Rx strategies that I swear by: a handheld misting fan and eating frozen cubes of watermelon!)

posted by daisyace to Health & Fitness (25 answers total)

I only have a little to share, but in case it helps: went on low-dose Effexor, immediately stopped sleeping altogether, went off it after six days because I could not function on zero sleep.

Another non-Rx aid: the Chilipad, though it's awfully pricey.
posted by humbug at 4:42 AM on September 15, 2022

For what it's worth, some SSRIs are easier to get off than others. (In particular, Prozac has a reputation for being easy to stop for most people, though some still struggle.)
posted by nebulawindphone at 4:49 AM on September 15, 2022

My partner had miserable hot and cold flashes and bad sleep and went on a very low dose of the Estradiol patch, and it turned out even that dose was too much with the side effects, so now they cut the patches in half and that dose provides relief from flashes without significant issues.
posted by seanmpuckett at 5:17 AM on September 15, 2022 [1 favorite]

Best answer: Seconding Estradiol patches at the lowest dose - knocked hot flashes out, gave me back a functioning libido, better mood regulation, better vaginal health and eliminated menopausal bone and head aches. It is a bit of a dance with adjusting dosage levels, but persevere over a few months if you can.
posted by honey-barbara at 5:34 AM on September 15, 2022 [1 favorite]

I’m on Estradiol patches too, along with Progesterone. I no longer have hot flashes or night sweats. I hadn’t noticed libido differences with menopause and haven’t noticed those kinds of impacts with HRT. One thing that changed for me - I had not been getting mammograms, but now need to do that annually because of the HRT. So - if, like me, you are medical care avoidant you may want to keep that in mind.
posted by hilaryjade at 5:59 AM on September 15, 2022 [1 favorite]

Best answer: I use gabapentin for sleep. It does not give me hangovers. I haven't noticed any side effects, but I had a larger than average appetite to begin with, so who knows?

It is the option that seems easiest to try out, because it won't take as long to determine if it helps.
posted by metasarah at 6:30 AM on September 15, 2022

I take a very low dose of Estriadol via pill every other day. It mostly knocks out the night sweats on me. The anxiety continue to be high, even with Prozac, but I think that's mostly to *waves around 2020 to today*.
posted by heathrowga at 6:49 AM on September 15, 2022 [1 favorite]

Best answer: I'm a doctor

Other than SSRI's and SNRI's, anti-hypertensives (lowers blood pressure) are often used to treat hot flashes. The three most common and best studied are:

Methyldopa
Propranolol
Clonidine

Two other medications are also used, though less often: Phenobarbital (an anti-seizure medication) and Ergotamine (prevents migraines)

All are viable alternatives to HRT. See what your doctor has to say
posted by BadgerDoctor at 7:22 AM on September 15, 2022 [1 favorite]

I currently have only one ovary and was having problems - not with a flash of heat or sweats, but like a slow blossom of heat that would travel up my chest into my head and linger. My anxiety also went from “ there but I can deal” to “I lie awake at night ruminating.” After a side trip through a couple of different meds, I ended up on Trintillex for the anxiety/depression and Clonadine (half tablet in the morning and afternoon then a whole pill at night.). The heat blossoms went away and I’m sleeping well. No side effects.
posted by PussKillian at 7:55 AM on September 15, 2022 [2 favorites]

Best answer: What's it like being on HRT? What format of it are you on? Having read up at NAMS and elsewhere, I'm comfortable with the risk profile, but not sure about side effects. Back when I was on the pill, it killed my libido dead. If you had that experience too, is it the same with HRT? If you've been on both the pill and HRT, how does it compare in general?

It's like not being on anything, certainly not like being on the pill. It's perfect. I am on Estrogen patches and I have a progesterone IUD and it is fucking glorious.
posted by DarlingBri at 8:05 AM on September 15, 2022 [3 favorites]

Your assessment of SSRIs is IMHO correct. I found when I had a rough time coming off my SSRI that 1) doctors tend to be very unhelpful about this 2) many people I knew also had struggled to quit the meds 3) there is a real lack of information on how common withdrawal is. YMMV.
posted by vanitas at 8:24 AM on September 15, 2022

In my many, many years of hot flashes I've tried many solutions. Early on, I was on HRT and it worked beautifully but my doctor took me off it at age 49. Since then, I've tried two different SSRIs (I can't remember which now, sorry). Both controlled the hot flashes but made me so anxious I couldn't tolerate them. I'm currently on propranolol for a different purpose and haven't noticed much effect on the hot flashes. Besides always having a folding fan handy, the only thing that has made a difference for me is cutting back on alcohol.
posted by DrGail at 8:26 AM on September 15, 2022

I'm on Estradiol patches + Progesterone, and I've gone up in strength on the patch slightly once over the last two years. I tried Combipatch first, which was really convenient, but found it didn't work with me as well (I had other menopause issues in addition to hot flashes that weren't addressed). I also have osteoporosis, so HRT was recommended for me specifically. It didn't affect my libido in any way.
posted by Mchelly at 8:44 AM on September 15, 2022

I used to use a cream for hot flashes, which worked but rubbing in the cream took forever and I just didn't want to do it anymore. I also was getting that menopause tummy and was looking for a solution for that. I stumbled upon prebiotics and probiotics that claimed to be for helping with the tummy. So, I bought them and discovered that my hot flashes had also gone away. I haven't had any hot flashes in two months while I've been taking these pills. I purchase the bundle: www.amazon.com/stores/BetterBodyCo/page/FFBB45F9-286F-4941-BDC5-9A8DE5DC6CC7?ref_=ast_bln
posted by poppunkcat at 8:59 AM on September 15, 2022

The chilipad is indeed not cheap, but if your primary issues are at night, it makes a big difference. Has for me, I can finally sleep through the night. I've only had mine for 6 weeks though so I can't speak to its longevity.

I do sort of wish it had a timer -- a temperature cold enough to keep the night sweats away is also cold enough to make me not want to get out of bed in the morning.
posted by nat at 10:39 AM on September 15, 2022 [1 favorite]

I’m in surgical menopause and can’t take estrogen. So I’m on testosterone only. It’s been fantastic. No hot flashes, increased libido and response, no endo flares or depression. Testosterone is often overlooked for people AFAB, even though it’s a hormone that changes with age and menopause and has been shown to help many hormonal symptoms at many ages.
posted by Crystalinne at 10:49 AM on September 15, 2022 [1 favorite]

My non-rx strategy was a plant-based diet with very low dairy and limited refined carbs. I just happened to go on this at the same time I started experiencing hot flashes, and after a few days noticed that the hot flashes had gone and they never reappeared, despite easing off the diet after some months. Maybe just a coincidence, but wanted to pass it along.
posted by nanook at 12:46 PM on September 15, 2022 [1 favorite]

My mother used to suffer terribly from hot flashes and couldn't take estrogen since she'd had breast cancer twice. I bought her an Embr Wave and it was a total game changer. It's a little device you wear on your wrist that quickly tricks your body into thinking it's cooler (or warmer) . It was originally to deal with chilly or overheated offices, but it's so often used by menopausal women that they started marketing it as a hot flash treatment almost exclusively.

She wears hers pretty much 24/7 except for the few hours it's charging.
posted by ananci at 12:50 PM on September 15, 2022 [3 favorites]

Best answer: I am on an estrogen patch + progesterone pills 10 days a month and, to echo DarlingBri, it is fucking glorious. I was having hot flashes, mood swings, and vaginal dryness. I started at the lowest dose, .025. The night before I took the first pill was my last hot flash ever. It stopped them in their tracks. I felt a little queasy and bloated the first few weeks, and was a little weepy during the first cycle of progesterone, but then those symptoms went away entirely. Now I'm on such an even keel emotionally I can hardly believe it. My libido is unchanged (it's good) but I get lubricated like a much younger version of myself. My former crime-scene periods are much lighter. And, bonus, I've lost a little weight. I worked my way up to .50 patches and think this is probably where I'll stay.

I've also been on SSRIs in the past and I feel so bad for Past Me. I think it was all hormonal. Those things really messed me up and were so hard to get off of. I wish I had known.
posted by HotToddy at 2:52 PM on September 15, 2022 [2 favorites]

Dried edamame as a snack, every other day, vanilla soy milk for coffee, or cereal, soy chorizo, tofu as the protein part of udon noodles. It does not have to be a lot of soy, just enough to back off the symptoms. You can make oatmeal cooked with vanilla soy milk each breakast, add blueberries, pecans, cinnamon, that regime is great for lowering cholesterol as well.
posted by Oyéah at 3:41 PM on September 15, 2022 [1 favorite]

Best answer: While I do not yet have hot flashes, I do have experience with both SSRIs and gabapentin. SSRIs can CAUSE night sweats. I know night sweats are not the same thing as hot flashes, but they can disrupt your sleep in a similar way. For me, the night sweats are horrible, but my anxiety is worse, so I'm still taking the SSRI. I started taking a low dose of gabapentin at night for an unrelated issue and by happy coincidence, it greatly reduced the sweating! I don't feel groggy in the morning and still have my regular insomnia, so it might be worth a try for you. On the plus side, you should know after just a couple nights whether it works for you and it doesn't have any habit-forming aspects to it that I know of. It's not even supposed to last a full 8 hours in your body. I haven't noticed a change in appetite and I'm already fat and didn't pay attention to that aspect.
posted by purple_bird at 4:00 PM on September 15, 2022 [1 favorite]

If you're interested in being in a clinical trial, the Advancing Postmenopausal Preventive Therapy study is still looking for participants.
posted by mogget at 4:26 PM on September 15, 2022

Best answer: Like you, in my first couple of years of menopause the hot flashes were intermittent--they would be bad for a while and then disappear for weeks or months. Then in year 3-4 they gradually became constant, and regularly disrupted my sleep, not to mention being sweaty and uncomfortable during the workday. I did not have the mood swings or rage other women report, but just felt physically uncomfortable because of hot flashes throughout the day. I was reluctant to try HRT, because I had only known the negative press from the years of my mother's experience--the Premarin generation. Then I started seeing more being written about the flaws of those earlier studies. About 8 months ago, I decided to give it a go, and I now wish I had started it much sooner.

I live in Australia and I am using a topical estrogen gel that I rub on my thighs before bed (does the same as the patch), paired with a progesterone pill. The hot flashes stopped almost instantly when I started taking it, and my sleep improved vastly. Like HotToddy, I wasn't having libido problems before, but the extra lubrication is nice. I had some weight gain in recent years that to me seemed menopause-related, though my doctor and many online sources insist that menopause and metabolism are not linked. I have lost a few pounds since starting HRT, but I think it may have more to do with being less tired and therefore able to exercise more. And there's the benefit of preventing osteoporosis.

However, I don't think hormones are your solution if you want to be able to stop and start all the time. Once you start HRT your hot flashes will stop, but that doesn't mean that you then stop taking it. Perhaps you are still transitioning from perimenopause, and it might be a while yet before you experience consistent symptoms. Or maybe your symptoms will never be that constant. Every woman seems to have different menopause experiences. For me the tipping point was feeling like menopause was seriously degrading my health and wellbeing.
posted by amusebuche at 12:13 AM on September 16, 2022 [1 favorite]

Response by poster: Thanks everybody -- this is really helpful. It's a great point that I can give gabapentin a quick try, and so encouraging to know that if it doesn't do the trick, HRT sounds SO much better than I'd thought. I'm going to have a look into some of the other suggested categories of meds et al. first, and I'll keep an eye here in case anyone else has something to add, but I'm already feeling much more optimistic about the options. If I have any info to add once I've tried something, I'll follow up here, too. I really appreciate it!
posted by daisyace at 4:04 PM on September 16, 2022 [1 favorite]

Just wanted to agree on the limited dairy (try none for a few weeks as an experiment?) and also adding soy if you can.
posted by Glinn at 4:22 PM on September 16, 2022 [1 favorite]