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Health Answers

Why do I still have hot flashes many years after menopause?

Q. Why do I still have hot flashes many years after menopause?

A. Jan Shifren, director of Massachusetts General Hospital’s Midlife Women’s Health Center, says that about three-fourths of women have bothersome hot flashes during menopause, and for the majority of them, the hot flashes subside after a few years. But not everyone is so fortunate. “There is this small group of women for whom they really last a very long time,” she says. A recent University of Pennsylvania study found that, among 255 older women, more than one-third had moderate-to-severe hot flashes for 10 years or more after menopause, suggesting that a significant number of women may need longer-term management of menopause symptoms.

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Shifren says it’s not clear why hot flashes persist in some women, but it does tend to run in families. People who are overweight or who smoke are also more susceptible to hot flashes.

Hormone therapy, the most common treatment, carries greater risks of adverse effects with age, including blood clots, dementia, and breast cancer. Older women seeking hormone therapy for hot flashes “would need to be very healthy and understand the benefits and risk,” she says. Other treatment options are available, including a non-hormonal treatment for menopause symptoms approved by the Food and Drug Administration last year, the low-dose antidepressant Brisdelle.

Over-the-counter treatments like black cohosh help some women manage long-term hot flashes, Shifren says, but haven’t proven themselves better than a placebo in studies. Keeping cool with fans, air conditioning, and loose clothing also helps.

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