Having hot flashes for 45 years not cool

DEAR DR. ROACH: I’m a 69year-old woman. I still have hot flashes since a partial hysterectomy at age 24. I have them day and night, and they are really getting on my nerves. My doctor is treating me with venlafaxine, which helps some. I was on an estrogen patch years ago. Is there something else I can try? Why am I still having them?

ANSWER: Hot flashes are caused by abnormal regulation of blood vessels in the skin. This is common when estrogen levels go down, either after surgery or, naturally, with menopause. The blood vessels dilate, causing heat and a flushing sensation, often followed by cold.

In most women, the hot flashes go away after a few years, but some women are unlucky enough that they go on indefinitely.

There are many treatments for hot flashes, but none of them is as effective as estrogen.

Unfortunately, estrogen has many serious potential side effects, and in women who start more than a few years after menopause, the risk for heart disease is so high that most physicians are uncomfortable prescribing it. It remains a high-risk option.

In women who are having moderate to severe symptoms and who cannot take estrogen, venlafaxine is a reasonable option.

If it isn’t adequate, then I normally would recommend a similar type of medication. Paroxetine is Food and Drug Administration indicated for treatment of hot flashes (Paroxetine can cause weight gain and must be stopped very slowly). Next is citalopram. If that doesn’t work, try gabapentin.

DEAR DR. ROACH: My father has nondiabetic peripheral neuropathy (due to a car accident). It is causing significant to unbearable pain, primarily in his feet, but also to some extent in his legs. Are there any treatments or medications that he could take to provide at least temporary relief from the pain?

ANSWER: One common firstline medication class is the tricyclic antidepressants, such as nortriptyline and amitriptyline. Although they were developed for depression, they work on the nerves themselves to reduce pain transmission, and do so at a much lower dose than that needed to treat depression.

Medicines to treat seizures, such as gabapentin (Neurontin) and pregabalin (Lyrica) can be effective at reducing nerve pain. N

Unfortunately, it often requires combinations of medications to be effective, and drugs may need to be changed due to side effects. A pain-management specialist is the best resource available.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.