In Detail
Hot flashes and night sweats — collectively called vasomotor symptoms — are among the most disruptive features of the menopausal transition. They are caused by changes in how the hypothalamus regulates body temperature as estrogen declines. For many women, vasomotor symptoms persist for seven to ten years if untreated.
Systemic estrogen therapy is the most effective treatment available for moderate to severe vasomotor symptoms. Transdermal estradiol — delivered through a patch, gel, or cream — restores the hormonal signal the hypothalamus is missing, typically reducing hot flash frequency and intensity within weeks. Women with a uterus also receive micronized progesterone to protect the endometrium.
Non-hormonal options exist for patients who cannot or prefer not to use estrogen, including certain SSRIs, gabapentin, and the newer neurokinin-3 receptor antagonists. At Atlas & Willow we discuss risks, benefits, and personal preferences before recommending a path.