Hot Flashes Persisting After Progestogen Therapy, with Contraindication to Estrogen
This protocol addresses menopausal women with vasomotor symptoms — particularly hot flashes — who cannot receive estrogen therapy due to a contraindication, and whose symptoms were not adequately controlled by the prior progestogen-based approach.
The patient presents with menopausal vasomotor symptoms (hot flashes) and has a contraindication to estrogen therapy. Progestogen alone — the hormonal alternative appropriate for women who cannot use estrogen — was already attempted as the first step.
Progestogen therapy (micronized progesterone or medroxyprogesterone acetate) was the prior treatment line. The clinical target — reduction of vasomotor symptoms (hot flashes) — was not achieved. This protocol represents the next step taken after that failure.
When estrogen cannot be used and progestogen has not adequately controlled hot flashes, non-hormonal prescription medications spanning more than one drug class provide an evidence-based alternative path toward vasomotor symptom relief. The complete structured selection — which agents apply, in what context, and how to choose among them — is detailed in the full protocol.
Reduction of vasomotor symptoms (hot flashes).
References
Progestogens alone may be used in women with contraindications to estrogen therapy.
For those with contraindications to hormone therapy or a desire to avoid it, SSRI/SNRIs, gabapentinoids, or clonidine may reduce VMS in some women.
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