Treatment of Menopause with Moderate to Severe Hot Flashes (Vasomotor Symptoms) in Women Without a Uterus

Clinical Scenario

This protocol addresses women in menopause presenting with moderate to severe hot flashes and vasomotor symptoms who have had a hysterectomy (absence of uterus) and have no contraindication to estrogen therapy.

Key Considerations

Moderate to severe vasomotor symptoms — including hot flashes and night sweats — are the primary indication driving this protocol. Menopausal hormone therapy is the gold standard for reducing these symptoms.

The absence of a uterus is clinically significant: women without a uterus are eligible for a simplified hormonal approach that is not available to those with an intact uterus.

Treatment Approach

The recommended approach involves systemic estrogen-alone therapy (ET), with several formulation types and routes of administration available. The full protocol specifies which options apply, along with the criteria for selecting among them.

Complete regimen details — including formulation, route, and clinical decision criteria — are in the full protocol below.

Clinical Goal

Reduction of vasomotor symptoms, including hot flashes and night sweats.

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References

MHT is the gold standard and best therapy for reduction of VMS, followed by non-hormonal prescription medications as a second choice.
Women without a uterus can use systemic estrogen-alone therapy (ET).
Systemic estrogen options: oral tablets, transdermal patches and transdermal gels.
Menopausal hormone therapy (systemic estrogen alone, or with appropriate endometrial protection in women with a uterus) is the current standard therapy for reduction of VMS.

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