Starting and Continuing the Conversation About Hot Flashes

Starting and Continuing the Conversation About Hot Flashes

Med-IQ Express
Online Course | Specialties: Family Medicine, Primary Care, Women's Health
Released: 12/30/2020
Expires: 12/29/2021
Max Credits: 0.25
Jump to Education

JoAnn V. Pinkerton, MD
Professor of Obstetrics and Gynecology
Division Director, Midlife Health Center
University of Virginia Health System
Charlottesville, VA

Activity Planners
Julie Blum, PhD
Director, Clinical Content
Baltimore, MD

Jane Frutchey, MS
Managing Editor
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager
Baltimore, MD

Amy Sison
Director of CME
Baltimore, MD

Katherine Kahn                                          
Holyoke, MA
Learning Objectives
Upon completion, participants should be able to:

  • Summarize the benefits and limitations of available and emerging/investigational hormonal and nonhormonal therapies for VMS during the menopause transition
  • Identify effective and evidence-based treatment strategies for women experiencing moderate to severe VMS  

Target Audience
This activity is intended for obstetricians, gynecologists, and primary care physicians.
Statement of Need
At least 75% of midlife women experience VMS or hot flashes usually for a duration of 5 to 7 years during their menopausal transition. These symptoms can be embarrassing and debilitating for women and negatively impact their daily living, sleep, concentration, and mood. Despite the significant burden and costs associated with VMS of menopause, they are often underrecognized and undertreated in midlife women. Physicians may not consistently inquire about menopausal symptoms because of time constraints, uncertainty of the best way to incorporate the discussion into unrelated office visits, or a lack of knowledge of best practices for managing VMS. When physicians do not initiate these conversations, it becomes the patient’s responsibility to do so. Therefore, it is crucial that patients have access to accurate and reliable information on evidence-based treatments for VMS. Healthcare providers also require this information to increase the frequency with which they initiate these conversations and to better individualize the treatment needs of their patients navigating the menopausal transition.

Providership Statement
Provided by Med-IQ.

Accreditation/Designation Statements
Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.  

Med-IQ designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Medium/Method of Participation
This CME activity consists of a 0.25-credit online publication. To receive credit, read the introductory CME material, read the publication, and complete the post-survey, evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.  

Initial Release Date: 12/30/20
Expiration Date: 12/29/21
Estimated Time to Complete This Activity: 15 minutes

Disclosure Policy
Med-IQ requires any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as those in any amount occurring within the past 12 months, including those of a spouse/life partner, that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and resolve COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Drug/Product Usage by Faculty
Off-label/unapproved drug uses or products are mentioned within this activity. 

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.

JoAnn V. Pinkerton, MD, has indicated no real or apparent conflicts. 
The writer, peer reviewers, and activity planners have no financial relationships to disclose.
Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, Med-IQ has a policy to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.

Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity. 
Contact Information
For questions or comments about this activity, please contact Med-IQ. Call (toll-free) 866 858 7434 or email

System Requirements



  • Operating system - Med-IQ supports the current operating system, plus two prior releases:
    • Android (eg, Samsung Galaxy)
    • Apple (eg, iPhone/iPad)
  • Browsers - Med-IQ supports the default browser for the applicable operating system release, plus two prior releases:
    • Android (Chrome)
    • Apple (Safari)

Applications & Software

For technical assistance, please refer to our Support Manual.

The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

Privacy & Confidentiality
Med-IQ is committed to honoring your privacy and protecting any personal information you choose to share with us. For detailed information about our privacy notice, please visit:

Acknowledgment of Commercial Support
This activity is supported by an educational grant from Astellas.
© 2020 Med-IQ, Inc.


Here are the key takeaways from this activity. Deeper insights and evidence, plus an opportunity to receive credit, are available at the "Continue" button below.

  • Although women report a variety of symptoms during menopause, VMS such as hot flashes, night sweats, and sleep and mood disturbances are most common
  • Only 60% of women with significant menopausal symptoms seek medical attention, and of those, nearly 75% do not receive treatment
  • HT has a crucial place in the management of VMS, especially for those in early menopause who have a low risk of breast cancer and heart disease
    • Estrogen monotherapy is recommended for women who have had a hysterectomy, whereas women with a uterus need either combined estrogen-progestogen therapy or the newer conjugated estrogens paired with the selective estrogen receptor modulator bazedoxifene
    • Guidelines suggest that the lowest effective estrogen dose should be used for VMS management for the shortest time possible; risks of HT appear to be different depending on type, dose, duration, route of administration, timing of initiation, and whether a progestogen is needed
    • Randomized controlled trials have found that both oral micronized progesterone and oral synthetic progestogens can be effective in treating VMS but should be avoided in women with breast cancer
  • Nonhormonal therapies tested in randomized controlled trials but used off label for VMS include SSRIs, SNRIs, gabapentinoids, clonidine, and oxybutynin; the only FDA-approved therapy for VMS currently is 7.5 mg paroxetine mesylate
  • Nonprescription therapies that appear to show benefit over placebo in controlled trials include hypnosis, cognitive behavioral therapy, and stress-reducing therapies
  • Emerging nonhormonal therapies such as stellate ganglion block, estetrol, and neurokinin receptor antagonists such as fezolinetant (investigational) have shown promise in reducing the frequency of moderate to severe hot flashes and other VMS

View reference list.

Click “Continue” to proceed through this activity and/or receive credit.

Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors.

The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

COPYRIGHTED. Republication or redistribution of Med‑IQ content, including by framing, is prohibited without prior written consent. Med‑IQ shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.