Editing Hot flash (section)

=== Hormone replacement therapy ===
[[Hormone replacement therapy (menopause)|Hormone replacement therapy]] may relieve many of the symptoms of menopause. However, oral HRT may increase the risk of breast cancer, stroke, and dementia and has other potentially serious short-term and long-term risks.<ref>{{cite web | author = U.S. Food and Drug Administration | author-link = Food and Drug Administration | title = FDA Updates Hormone Therapy Information for Post Menopausal Women | work = FDA News Release (Archived content) | publisher = U.S. Food and Drug Administration | date = 10 February 2004 | url = https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2004/ucm108243.htm | archive-url = https://web.archive.org/web/20090710102654/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2004/ucm108243.htm | url-status = dead | archive-date = 10 July 2009 | access-date = 19 April 2013}}</ref><ref>{{cite journal | vauthors = Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J | display-authors = 6 | title = Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial | journal = JAMA | volume = 288 | issue = 3 | pages = 321–33 | date = July 2002 | pmid = 12117397 | doi = 10.1001/jama.288.3.321 | doi-access = free }}</ref> Since the incidence of cardiovascular disease in women has shown a rise that matches the increase in the number of post menopausal women, recent studies have examined the benefits and side effects of oral versus transdermal application of different estrogens and found that transdermal applications of estradiol may give the vascular benefits lowering the incidences of cardiovascular events with fewer adverse side effects than oral preparations.<ref>{{cite journal | vauthors = Serock MR, Wells AK, Khalil RA | title = Modulators of vascular sex hormone receptors and their effects in estrogen-deficiency states associated with menopause | journal = Recent Patents on Cardiovascular Drug Discovery | volume = 3 | issue = 3 | pages = 165–86 | date = November 2008 | pmid = 18991792 | doi = 10.2174/157489008786263970 | url = http://www.eurekaselect.com/83481/article | url-access = subscription }}</ref><ref>{{cite journal | vauthors = Løkkegaard E, Andreasen AH, Jacobsen RK, Nielsen LH, Agger C, Lidegaard Ø | title = Hormone therapy and risk of myocardial infarction: a national register study | journal = European Heart Journal | volume = 29 | issue = 21 | pages = 2660–8 | date = November 2008 | pmid = 18826989 | doi = 10.1093/eurheartj/ehn408 | url = http://www.eurekaselect.com/83481/article | doi-access = free }}</ref>

Women who experience troublesome hot flashes are advised by some to try alternatives to hormonal therapies as the first line of treatment. If a woman chooses hormones, they suggest she take the lowest dose that alleviates her symptoms for as short a time as possible.<ref>{{cite web | url=https://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118624.htm | archive-url=https://web.archive.org/web/20090614054405/http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118624.htm | url-status=dead | archive-date=14 June 2009 | title=For Women - Menopause and Hormones: Common Questions| website=[[Food and Drug Administration]]}}</ref> The US Endocrine Society concluded that women taking hormone replacement therapy for 5 years or more experienced overall benefits in their symptoms including relief of hot flashes and symptoms of urogenital atrophy and prevention of fractures and diabetes.<ref>{{cite journal | vauthors = Santen RJ, Allred DC, Ardoin SP, Archer DF, Boyd N, Braunstein GD, Burger HG, Colditz GA, Davis SR, Gambacciani M, Gower BA, Henderson VW, Jarjour WN, Karas RH, Kleerekoper M, Lobo RA, Manson JE, Marsden J, Martin KA, Martin L, Pinkerton JV, Rubinow DR, Teede H, Thiboutot DM, Utian WH | display-authors = 6 | title = Postmenopausal hormone therapy: an Endocrine Society scientific statement | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 95 | issue = 7 Suppl 1 | pages = s1–s66 | date = July 2010 | pmid = 20566620 | pmc = 6287288 | doi = 10.1210/jc.2009-2509 }}</ref>

When estrogen as estradiol is used transdermally as a patch, gel, or pessary with micronized progesterone this may avoid the serious side effects associated with oral estradiol HRT since this avoids first pass metabolism ([[Drug metabolism|Phase I drug metabolism]]).<ref>{{cite journal | vauthors = L'Hermite M | title = HRT optimization, using transdermal estradiol plus micronized progesterone, a safer HRT | journal = Climacteric | volume = 16 | pages = 44–53 | date = August 2013 | issue = Suppl 1 | pmid = 23848491 | doi = 10.3109/13697137.2013.808563 | s2cid = 20401584 }}</ref> Women taking bioidentical estrogen, orally or transdermally, who have a uterus must still take a progestin or micronized progesterone to lower the risk of endometrial cancer. A French study of 80,391 postmenopausal women followed for several years concluded that estrogen in combination with micronized progesterone is not associated with an increased risk of breast cancer.<ref>{{cite journal | vauthors = Fournier A, Fabre A, Mesrine S, Boutron-Ruault MC, Berrino F, Clavel-Chapelon F | title = Use of different postmenopausal hormone therapies and risk of histology- and hormone receptor-defined invasive breast cancer | journal = Journal of Clinical Oncology | volume = 26 | issue = 8 | pages = 1260–8 | date = March 2008 | pmid = 18323549 | pmc = 2346534 | doi = 10.1200/jco.2007.13.4338 }}</ref> The natural, plant-derived progesterone creams sold over the counter contain too little progesterone to be effective.  Wild yam (''Dioscorea villosa'') extract creams are not effective since the natural progesterone present in the extract is not bioavailable.<ref>{{cite web | author = Harvard Women's Health Watch | author-link = Harvard Women's Health Watch | title = What are bioidentical hormones? |publisher=Harvard Women's Health Watch | date = August 2006 | url = http://www.health.harvard.edu/newsweek/What-are-bioidentical-hormones.htm | access-date = 20 September 2014}}</ref>