Consider Extending Duration of HRT for Hot Flashes

Current usage guidelines for hormone replacement therapy (HRT) may not be long enough, researchers suggest after finding that more than a third of women have hot flashes 10 years after menopause.

Guidelines often suggest discontinuing hormone therapy after 3 to 5 years of use, the authors note. However, the findings from studying the long-term risk of hot flashes after natural menopause in 255 women over 16 years suggests that moderate to severe hot flashes continue an average of nearly 5 years, with many women experiencing symptoms for longer. Of the 255 women, 80% reported moderate to severe hot flashes, 17% reported mild hot flashes, and 3% reported no hot flashes. 

Pertinent Points

- One third of women have hot flashes 10 years after menopause.

- African-American women and obese white women are at greater risk for hot flashes than non-obese white women.

- Women with higher education had a reduced risk of hot flashes.

Additional study findings were that the prevalence of moderate to severe hot flashes increased in each premenopausal year, reaching a peak of 46% in the first 2 years after the final menstrual period, the authors reported in the journal Menopause. Hot flashes decreased slowly after menopause and did not return to premenopausal levels until 9 years after the last menstrual period, they found.

"Our findings point to the importance of individualized treatments that take into account each woman's risks and benefits when selecting hormone or non-hormone therapy for menopausal symptoms," said the study's lead author, Ellen W. Freeman, PhD, research professor in the department of obstetrics and gynecology at Penn Medicine, in a news release.

In this study, significant risk factors for hot flashes included an increase in levels of follicle-stimulating hormone before the final menstrual period, a decrease in levels of estradiol, and an increase in feelings of anxiety, the authors wrote.

The authors also found that African American women and obese white women had significantly greater risks of hot flashes compared with non-obese white women (interaction, P=0.01). Of interest, women with education beyond high school had a 34% lower risk of hot flashes (odds ratio, 0.66; 95% CI, 0.47-0.91; P=0.011). The latter finding warrants additional study, the authors said.