Hot flashes deserve treatment. Your heart history belongs in the decision.

What the new guidance says

The advice comes from a review of research. A guideline helps healthcare professionals decide which treatments to offer.

For women who still have a uterus, or womb, ACP recommends estrogen with a second hormone, such as progesterone. That second hormone helps protect the lining of the womb. Women whose womb has been removed can usually use estrogen alone.

You may hear this called a “first-line” treatment. That means an option to consider first when it is right for you. It does not mean every woman needs hormones. Your healthcare professional should explain the likely benefits and risks, then help you choose.

Sources: 1, 2, 3

Which symptoms are we treating?

For hot flashes and night sweats, treatment needs to send estrogen throughout the body. A skin patch or pill can do this.

Small doses of estrogen used inside the vagina mainly help with vaginal dryness and painful sex. That treatment is different from taking hormones for hot flashes. Tell your healthcare professional which symptoms you want help with.

Be specific at your visit. How often are you waking? Are you changing your clothes or bedding? Are symptoms interrupting work? Describing the effect on your day gives the conversation somewhere useful to begin.

Sources: 3, 4

Where your heart history comes in

Hormone therapy should not be started just to prevent heart disease. Even if your hot flashes improve, you still need a plan for your blood pressure, cholesterol and other heart risks.

For many otherwise healthy women under 60, or within 10 years of menopause, the benefits of hormone treatment may outweigh the risks. Your age is only part of the decision.

A past heart attack, stroke, blood clot, certain cancers or liver disease can mean that hormones sent throughout the body are not a safe choice. Tell your healthcare professional if any of these applies to you. Vaginal bleeding with no known cause also needs to be checked.

Estrogen delivered through the skin may be less likely to cause blood clots than estrogen taken by mouth. A patch still needs to be checked against your own health history.

Sources: 3, 4

Mention what happened during pregnancy

Did you have preeclampsia, a pregnancy complication involving high blood pressure? Diabetes diagnosed during pregnancy, called gestational diabetes? Or a baby born early? These can be clues to a higher chance of heart disease later in life. The American Heart Association recommends keeping these details in your health record.

These experiences do not automatically mean you cannot use hormones. They give your healthcare professional more information to consider. Share what happened and roughly when. If you had heart failure during or after pregnancy, mention that too.

As a physician assistant and a mother who experienced pregnancy-related heart failure, I care about what happens when one chapter of a woman's health gets left out of the next. This is why I created HEART RESERVE. I want women to have a way to bring those chapters together.

Sources: 5

Bring your pregnancy history into your next heart-health visit

What if I cannot take hormones?

There are prescription medicines for hot flashes that do not contain hormones. ACP includes several of these options in its advice. Your healthcare professional can explain which may work for you, taking your health and other medicines into account.

Ask how much relief to expect, what side effects to watch for and whether you will need any blood tests or other checks. If a treatment makes you feel unwell or costs more than you can afford, ask about another option.

Sources: 1

What I would bring to the appointment

A short note is enough. Start with the symptom that is making life hardest, then add the history you do not want overlooked.

• When your periods or symptoms changed, and how symptoms affect sleep and daily life.
• Whether you have had surgery to remove your womb, any bleeding with no known cause, and the medicines or hormones you take.
• Problems during pregnancy, your past health conditions, and illnesses that run in your family.
• Recent blood-pressure readings and cholesterol or blood-sugar results, if you have them.

You do not need a perfect record to ask for help. You can begin with: “I am not sleeping well, and I want to discuss treatment. Can we look at my symptoms and health history together?”

That is the conversation I want HEART RESERVE to help you have.