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    USAKDOG posted:
    I am 54 years old and postmenopausal. No period for 5 years. I was on HRT for two and a half years and stopped. Recently I have been experiencing severe hot flashes and some severe anxiety. I talked with nurse practitioner that stated that menopausal symptoms can return when HRT was used in the onset. She suggested an anti-depressant, Celexa, which my pharmacist said was not a good choice. What other options do I have that would be safer to help me through this.
    Mary Jane Minkin, MD responded:
    Dear USAKDOG,
    Unfortunately, some women do experience persistent hot flashes. About 15% of women have moderate to severe hot flashes that can last for over 10 years. For women who do not choose to remain on hormone therapy, there are other options. For over the counter remedies, my patients have had the best responses to Remifemin (black cohosh) and "Icool", which contains isoflavones, which are weak plant estrogens (like soy). Of non hormonal options, SSRI and SNRI antidepressants do work well for many women; a new medication has just been approved, and will be available in the fall, called Brisdelle; it is a very low dose of the antidepressant Paroxetine, which seems to avoid some of the annoying side effects of SSRI's, with its low dose, but does give hot flash relief. Celexa is quite a reasonable SSRI; I'm not sure why your pharmacist nixed it. The other choice of categories is the drug Gabapentin (neurontin)-used at night, it can help with hot flashes and sleep. The major drawbacks to the antidepressant category and Gabapentin are possible side effects; so you want to be working with your health care provider to help you.
    Good luck,
    Mary Jane
    USAKDOG replied to Mary Jane Minkin, MD's response:
    I was just wondering if your patients found relief from the anxiety with the Remifemin or "I Cool". That is really my major problem. I would like to avoid the antidepressants.
    Mary Jane Minkin, MD replied to USAKDOG's response:
    Dear USAKDOG,
    Some have; and it's certainly worth a try. Of course, if you just have occasional anxiety, you could consider taking an occasional dose of a medication such as Xanax or Ativan. But I'd give the Remifemin and Icool a chance.
    Good luck,
    Mary Jane

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