Symptoms of menopause: hot flushes

Vasomotor symptoms (VMSs) are highly prevalent during the peri- and early postmenopause. They constitute a major driver for patient self-referral for medical care. Although most women will experience an abatement of their VMS by 5 years after their final menses, women with early or surgical menopause may have worse or more persistent symptoms, and up to 16% of naturally menopausal women continue to experience VMS well after their menopause is past. Although estrogen is the most effective known therapy, it is neither appropriate nor desirable for every symptomatic woman, and nonhormonal treatments such as gabapentin, selective serotonin reuptake inhibitors/selective norepinephrine reuptake inhibitors drugs, and the antihypertensives clonidine and alphamethyldopa may be helpful for some women. There is mounting evidence to support the ineffectiveness of many proposed complementary and alternative modalities. This review will highlight the natural history of VMS and the current medical evidence supporting various treatments.