New therapeutic approaches for hot flashes in women.

While most women will suffer from hot flashes at some point over their lifetime, most symptoms resolve with time. However, some women may experience severe and/or long-lasting hot flashes. Estrogen, the most effective treatment for hot flashes, is not generally recommended for women with a history of breast cancer or women at high risk of developing breast cancer. Moreover, long-term administration of estrogen to healthy women is associated with increased risks of cardiovascular disease, stroke, and breast cancer. Newer antidepressants from the selective serotonin or noradrenergic reuptake inhibitor family, such as venlafaxine and paroxetine, appear to be among the most effective nonhormonal agents for the treatment of hot flashes. New information demonstrates that gabapentin also is an effective nonhormonal therapy for hot flashes. In this review, we will discuss current knowledge of the epidemiology and pathophysiology of hot flashes, along with treatment options. We will focus on nonhormonal treatments that have been studied in prospective randomized clinical trials, and will present an algorithm for the treatment of symptomatic patients.