<prompt> Hormonal therapy is indicated in menopausal women forHot flashesCarcinoma breastEndometriosisUterine bleeding  <response>: A Hot flashes?Hot Flashes:They are sudden, intense feelings of heat in the neck face, and torso. They can be accopanied by:Heart palpitations; Sleep disturbances; Profuse perspiration; Cold chills; Anxiety; FlushingHot flashes are: Mainly women over 40 as they transition into menopause as well as pregnant women.Other causes of Hot Flushes:Thyroid disease, epilepsy, autoimmune disorders, insulinomas, pancreatic tumors, leukemias.Hot flushes are waves of vasodilation affecting face neck last for 2-5 min each more severe during night, disturb sleep.Mechanism:Estrogen deficiency - Reduces hypothalamine endorphine - Release more norepinephrine serotonin - Leads to inappropriate heat loss mechanism.Hormonal Replacement Therapy:Benefit of HRT for Relief of Symptoms:Hot flashes: Highly effective; Usually required for a relatively short period of time, E.g., 1 to 3 years.Mood disturbance: Improve irritability anxiety in many menopausal women; Relieve mild depressive symptoms.Hormone Replacement Therapy HRT is indicated in menopausal women to overcome the short-term and long-term consequences of estrogen deficiency. HRT can be administered orally in pill form, vaginally as a cream or trans dermally in patch form because it replaces female hormones produced by the ovaries, hormone replacement therapy minimize menopause symptoms. Used before, during after menopause.Who needs HRT:Symptomatic women who suffer from estrogen deficiency Therapeutic; High risk cases for menopausal complications such as cardiovascular disease, osteoporosis, stroke, Alzheimers disease, colonic cancer prophylacticPremature surgical menopause; Gonadal dysgenesis in adolescents.Treatment of Hot Flashes: If mild symptoms signs advised exercise.Initiate low dose HRT if:Moderate or severe symptoms: Non-hormonal treatments have failed; No interest in non-hormonal therapyTitrate estrogen dosage upward if needed.When estrogen cant be used, offer:SSRI or SNRI; Gabapentin, clonidine, alpha-methyldopa; MPA or MegesterolAttempt discontinuation after 1-2 yearsTREATMENT OPTIONS FOR MENOPAUSAL SYMPTOMS SHOWN TO HAVE CLINICAL BENEFITSSymptomsHormone TherapyNon-hormonal TreatmentsLifestyle ChangeVasomotorOral conjugated estrogens and MPAParoxetineSmoking cessationContinuous and sequentialVenlafaxineDecrease alcohol consumptionOral estradiol and norgestimatelGabapentinRelaxation techniquesTransdermal. 17 beta estradiol-norethindrone acetate. 17 beta estradiol - levonogestre. 17 beta estradiol. EstradiolClonidine Oral conjugated estrogen unopposedOral 17 beta estradiolEstradiol vaginal ringVaginal atrophyEstradiol vaginal creamVaginal moisturizersSmoking cessationConjugated estrogen vaginal creamVaginal lubricantsregular sexual activityEstradiol vaginal ring OsteoporosisHT not recommended as first-line therapy for prevention or treatmentCalcium Vitamin D supplementsWeight bearing exercisesBisphosphonatesSmoking cessationRaloxifeneDecrease alcohol consumptionCalcitonin Teriparatide 