DEAR DOCTOR K:
Recently you wrote about a patient who was still having hot flashes in her early 70s, long after menopause. I’m in my 60s, and I still have them. How long might they last?
Following the publication of that column, I got many letters with questions like yours. These letters also described what it is like to suffer from hot flashes.
One reader recalled driving with her parents on a bitter cold winter night. Suddenly, her mother had a hot flash. It was so bad that she “turned the heater off, opened the car windows and stuck her head out the window. My father asked her what the heck she was doing.”
Or: “Take a shower — forget it. You dry yourself off, and then you are just as wet as you were. And you stay that way for a good half-hour.”
In my column I had advised removing as much clothing as possible to allow the release of body heat. A reader wrote: “I can’t strip down any further. I’d be arrested.”
These letters reminded me of a patient of mine who said that she had suffered from hot flashes since her periods stopped, at age 54. Since then, “I have good months and bad months, but they’re always there. They’ve become a part of my life.” What made the patient remarkable was that she was 89 years old.
Several large research studies on this subject, involving hundreds of thousands of women, have been published in the past decade. They (finally) demonstrate what patients have been saying all along. One study from Sweden found that 9 percent of women age 72 were still bothered by hot flashes. A study from the United States found that 20 percent of women who were more than 20 years past menopause still had hot flashes. Another recent study from the U.S. found that in women who began to experience hot flashes before their menstrual periods stopped, hot flashes persisted in nearly 70 percent 12 years after menopause.
What treatments should you consider? In my opinion (it’s a controversial area), hormone therapy is generally the best option for the first 10 years following menopause (unless breast cancer runs in your family). Beyond 10 years, hormone therapy starts to increase a woman’s risk for heart disease.
After that, other treatments can be effective. This includes a drug called clonidine, the SSRI and SNRI drugs used for depression, and two drugs used to treat seizures and nerve pain, gabapentin and pregabalin. (It’s not that hot flashes are a sign of depression or seizures. It’s that medicines used to treat those problems also are effective against hot flashes.)
So to the many readers who said their doctors didn’t appear to believe that they were still having hot flashes a decade or more after menopause, my advice to you is simple. Tell them that many scientific studies support what you are saying.