![]() Hormone therapy (estrogen with or without progestin) remains the predominant and only FDA approved treatment for menopausal hot flashes, but use markedly decreased following the release of findings from the Women’s Health Initiative Estrogen Plus Progestin Trial that identified the delicate balance of risks versus benefits of combined hormone therapy.( 9 10) Increasingly prescribed to women in midlife( 11), selective serotonin and serotonin norepinephrine reuptake inhibitors (SSRIs and SNRIs) have shown modest efficacy in reducing hot flash frequency and severity in prior randomized controlled trials, ( 12),( 13) but use of SSRIs/SNRIs for treatment of hot flashes is limited by concerns about commonly reported side effects, including insomnia and somnolence.( 4 14) However, it is also plausible that SSRIs/SNRIs may improve sleep in parallel with reducing hot flash frequency and severity. ![]() Prior cross-sectional studies have reported a graded association between hot flashes and insomnia symptoms( 5 6), though the exact role that hot flashes play in sleep complaints of menopausal women remains controversial.( 7 8) Self-reported sleep complaints are common in perimenopausal and postmenopausal women( 1– 3) and have been identified as a key symptom of the menopause transition.( 4) Menopause-related sleep disturbance has often been attributed at least in part to nocturnal hot flashes.
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