Hot Flushes every hour on the hour

[ladybirdbirdlady]

For the past week I've started having hot flushes, they've been horrible in this heatwave, and after timing them today realised they're coming every hour, day and night.
Does this mean menopause has properly started? Periods have been a bit irregular but no other symptoms until this. Not sure how many more days of this I can take, and Google suggests hot flushes can last for 10 years or never go away. Really??

I had unbearable hot flushes - sweat dripping down my face and body. Utter misery. What helped IMMEDIATELY was the antidepressant venlafaxine 37.5mg immediate release tablets twice a day. It's prescribed off label for hot flushes. It knocked them on the head straight away. Better than HRT for me. Hope that's helpful. The relief was huge. They also stopped my constant weeping that also crept up on me with menopause. I could barely start a sentence without crying. X

Thank you! Never heard of venlafaxine so a bit of googling to do. Did you have to suffer the flushes for an extended period of time before being prescribed? I've had such broken sleep for the past week or so, I don't know if I could keep this up for weeks/months.
I'm not feeling weepy, more irritable and a bit short tempered!

I tried to put up with the hot flashes for a few weeks but couldn't handle them. They messed up my whole adrenal system as well (my GP said that's normal) - ie, often things would make me jump, like not realising someone was standing behind my chair at work, for example, and it would trigger a massive hot flush. I had them all the time. If I felt remotely stressed: hot flush. Running for a train: hot flush. Drying my hair: hot flush (dripping). I couldn't handle them. The day I started the venlafaxine they stopped. Maybe one or two poked through but maybe for 2 days then nothing. Don't suffer through them. It will help your irritability too. And don't worry about asking for it. I ASKED for the venlafaxine as I had been recommended it. Don't feel you can't ask. My doc knew all about it anyway and was happy to prescribe it.

Have you had other benefits from taking Veloflaxine? Has it helped with sleep?
Also has it affected your weight?

You lose weight! It can make you sweat at night a bit ironically but I didn't care about that because I was at home in bed. But not hot flush type sweating. It's just a side effect of the medication that SOME people get. Some don't. It's not good for libido but, frankly, I was beyond caring. I just wanted to not feel like a weeping, crazy shrew and more importantly get rid of the unbearable hot flushes. It was worth it for that - and mood and weight benefits.

@ladybirdbirdlady @SugarCraving

This is exactly the product and make i took and the dose - two a day - one in the morning and one at night.

It’s great that Venlafaxine helped for Raffington, but I would be extremely cautious before starting on it: be aware of one of the most notorious side effects as an ‚older‘ generation medication: it can cause hugely distressing ‘brain zaps‘ if you’re just a short time late taking a dose, and it’s one of the more difficult anti-depressants to wean yourself off when you no longer need it because the effects are so tough to get through. There have been several threads on MN about just how difficult it is. For that reason I would never recommend it unless there’s no other option (ie other meds have not worked). I’m sure there are less insidious ways of dealing with hot flushes.

At a very small sub clinical dose this is unlikely - people who take venlafaxine for depression take about 300 mg a day or more. Also, there is the possibility of taking the sustained release version (XR) of the drug which makes coming off it much gentler or gaps between doses (if you run out for example) smoother. For hot flushes, I found the 2 x 37.5 mg a day immediate release dose more effective than the XR and this is such a small dose that there were no unwanted effects.

That’s just not true Raffington, sub-clinical doses can most certainly produce troubling side-effects in a portion of patients. I know because I was prescribed 37.5 daily off label for a pain condition, not depression, and the brain zaps were there nonetheless, and bizarrely they recurred for months after I stopped taking it. Getting down from that final 37.5 to zero seems to be the stumbling block for many people. Like I said, it’s great it works for you, few side effects will be experienced by 100% of people who take a medicine, but OP does need to bear this particular factor in mind when deciding how to approach her hot flushes. In my experience, doctors are keen to deny the extent of the problem.

What totally worked for me, for instance, was taking a progesterone-only pill (I can’t take oestrogen) - haven’t had a hot flush in four years. But there are certain risks to that path too, and a good doctor will weigh up risks and benefits for all potential meds and discuss them with you.

Are you sure it isn't just the hot weather? To come on so suddenly to coincide with a heatwave and to be all day and all night does suggest it may be temperature related rather than hormonal. I know anecdotally overheating can come on all at once but generally women have the odd one and then it fluctuates and either increases or plateaus.

I would wait for the weather to cool and see what you're like then tbh before asking for meds. I think everyone has had broken sleep for the last couple of weeks. Have you got an air conditioning unit for your bedroom?

If you have symptoms suggesting your natural oestrogen levels are decreasing you need to talk to a doctor about replacing those levels with NHS-provided, body-identical, plant-based oestrogen gel or patches, plus progesterone.

Um, I think what you mean to say is ‘that just wasn’t true FOR ME’. It’s not great to tell someone that what they have suggested is ‘just not true’ because it wasn’t the case for you. I’m tempted, for example, to suggest that taking a progesterone only pill removed your hot flushes completely is JUST NOT TRUE as it’s an absence of ESTROGEN that causes hot flushes, not progesterone. But I wouldn’t be so rude. That’s your experience. Possibly a placebo effect. You seem to know better than doctors, too, saying they are wrong about venlafaxine. Don’t be negative about something that could give women tremendous relief from the misery of hot flushes.

It's loss of estrogen.

@Raffington55 This crops up often here. And don't worry about asking for it. I ASKED for the venlafaxine as I had been recommended it.

Asked who?

Antidepressants are not prescribed for menopause symptoms now (since 2015) unless for women who have had breast cancer or other estrogen-driven cancer and can't use HRT.

NICE have said in very strong terms that GPs are not to prescribe these.
They have side effects, can be addictive and may also cause other serious health issues used long term.

It is rather surprising your GP isn't up to date on menopause symptoms.

Over the last few years the media has been full of accounts from women who were prescribed ADs and how this was wrong.

@ladybirdbirdlady The treatment for hot flushes is HRT.

@JinglingSpringbells I asked my GP, in 2016. And she prescribed venlafaxine for hot flushes until the end of 2020. Who else would I have asked? SSRIs and SNRIs (venlafaxine is an SNRI) are not addictive. Tranquillisers (such as benzodiazepines) are addictive. All medications come with side effects. To upset you even further no doubt, I was also prescribed testosterone during menopause for energy and libido, which I did not request. It was offered. Some GP practices are just more switched on/helpful/progressive than others I guess.

Goodness, you’re a very angry person, aren’t you. Maybe some proper HRT would help, rather than some random and outdated anti-depressants that, as has been pointed out, are no longer recommended for meno symptoms.
I would love to have been able to take proper HRT with oestrogen, it wasn’t medically possible. Getting rid of the hot flushes was an added (surprise) bonus, maybe it was a placebo who knows, lots of things are - the same can be said for you taking venlafaxine. But that doesn’t take away from the fact that many, many people (but obviously not all) who take venlafaxine have problems with the brain zaps and withdrawal, and OP should be aware of that beforehand. I’m not denying women anything, don’t be silly - but all patients need to be given an honest evaluation of pros and cons of a medication before starting it. And from what Jingling has written, no doctors following current guidance would prescribe it anyway.

@LadyGreySpillsTheTea not angry at all. And your comment about my needing proper HRT as a result instead of a random outdated antidepressant is just plain nasty. And, actually, I've had fibrocystic breast disease since the age of 26, which is why I didn't want to take estrogen in HRT (even though you can) as the condition is extremely painful and much worse if you add estrogen to the mix. I don't need HRT or venlafaxine at all now as post menopausal. Good luck with the struggle. Be kinder!

Why would I be upset for informing you of NICE guidance?
I am reporting medical advice. It's not personal opinion.

The NICE guidance is very clear.
Just because your GP decided to go along with your request, doesn't make her right at all. It's not 'progressive' or 'switched on' to ignore the guidance of NICE. It's the old way of treating hot flushes and no menopause specialist would do that, except it HRT was unsuitable.

NICE [[https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms

1.4 Managing short-term menopausal symptoms
The recommendations in this section are not intended for women with premature ovarian insufficiency (see recommendations on the management of premature ovarian insufficiency).

1.4.1Adapt a woman's treatment as needed, based on her changing symptoms.

Vasomotor symptoms1.4.2Offer women HRT for vasomotor symptoms after discussing with them the short-term (up to 5 years) and longer-term benefits and risks. Offer a choice of preparations as follows:

• oestrogen and progestogen to women with a uterus

• oestrogen alone to women without a uterus.

1.4.3Do not routinely offer selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) or clonidine as first-line treatment for vasomotor symptoms alone.

1.4.4 Explain to women that there is some evidence that isoflavones or black cohosh may relieve vasomotor symptoms. However, explain that:

• multiple preparations are available and their safety is uncertain

• different preparations may vary

• interactions with other medicines have been reported.

You are right that SSRIS are not 'addictive' in the true sense but they do come with the risk of withdrawal symptoms. These often mimic the very symptoms they are supposed to treat. And people find it hard to come off them because they don't recognise them as withdrawal symptoms, so are put back on them.
They were never trialled in long term studies and the guidance now is to review after 6 months.

I ASKED for the venlafaxine as I had been recommended it.

The question was 'who recommended it' and you then asked your GP.

If you have specific circumstances that mean HRT is not suitable [as I mentioned at above] there are options.

The OP does not say she can't use HRT. Therefore ADs are not first line treatment.

@ladybirdbirdlady I was like you- hourly flushes. I gave it about a month to see if it was blip. But it wasn't.

It's quite normal to have flushes and other symptoms even if your periods are sort-of regular.

If you carry on getting them, are you happy to consider HRT?

First line treatment is HRT (unless you have medical conditions that make them unsuitable.)

Many of us have said here that HRT sorted the flushes within days.

And yes, they can carry on for a long time. The average is evidently 7 years but around 10% of women have them for life (without HRT). My consultant says he has patients who have never got rid of them and I know older friends and family still having them in their 80s.

So, don't feel you can't talk to your GP about it if you feel the need.