A:

The number of menopausal hot flashes usually goes down with time. So one possibility is to wait to see if they improve on their own. While you wait, here are some lifestyle changes to help you cope with the hot flashes:

• Dress in layers. You can remove or add clothing as your body temperature goes up and down.
• Stay well hydrated, especially with a cool beverage during a hot flash.
• Start a program of vigorous exercise. Some women find this makes a big difference. Check with your doctor if this is safe for you.

Estrogen is the most effective prescription medicine. It relieves hot flashes in over 90% of women who use it. But many women cannot take estrogen because of its side effects. One major one is the formation of blood clots.

Other prescription medicine that has been shown to reduce hot flashes are gabapentin, antidepressants and progesterone. But none of these is as effective as estrogen. Talk over the pros and cons of these drugs with your doctor to see if one is best for you.

Estrogens derived from plants (phytoestrogens) may help some women with hot flashes. But they have not been proven to be effective in larger scientific studies.

There have also been claims that other natural products — such as the herb black cohosh and evening primrose oil — can help. But these have not shown to be better than a placebo (“sugar pill”) in clinical trials. There have been concerns about the safety of some herbal products. So be cautious if you choose to use these products.