Unfortunately, yes, hot flashes can last 15 years

Dear Dr. Roach: I started going through natural menopause in my late 50s. I will be 65 in September. Should I still be having hot flashes? — B.G.

Answer: Unfortunately, some women (perhaps 25 percent) will continue to have hot flashes 15 years out from the start of menopause. There are many treatments for hot flashes, but although estrogens are the most effective, the risk of starting hormone replacement at age 65 is considerably higher than at age 50, so most clinicians are uncomfortable prescribing them.

Before thinking about medication, however, many women (and a few men, such as those on hormonal treatment for prostate cancer) have found non-medicinal ways to deal with them. Layers of clothing are key — take extra layers off when hot, but recognize that so much body heat can be lost, a person actually can shiver when the flash is over. Keeping the room cooler will help as well. Anyone living with you may just have to deal with that. Handheld fans are great for some.

Prescription medications include medicines normally used for depression (like venlafaxine, citalopram or paroxetine) and for seizures (gabapentin often is prescribed, especially if symptoms are worse at night). Various supplements are used, but estrogen-containing ones, even plant estrogens, may have significant though poorly quantified risks. A new class of medicines (NK3 inhibitors) still is being studied and may be very beneficial, but it seems like I’ve been saying that for a while now. Food and Drug Administration approval sometimes can take years.

Email questions to ToYourGoodHealth@med.cornell.edu.