Managing Hot Flashes & Sleep at 47 You're likely in perimenopause, and there are good options across a spectrum: Medical Treatments (Most Effective) Hormone Therapy (HRT/MHT) Estradiol patches (Vivelle-Dot, Climara) + progesterone (Prometrium) — considered the gold standard for most healthy women Talk to your OB-GYN or a menopause specialist; current evidence shows it's safer than older studies suggested Non-Hormone Prescriptions Brisdelle or Paxil CR (low-dose paroxetine) — FDA-approved specifically for hot flashes Veozah (fezolinetant) — newer, non-hormonal FDA-approved option specifically for hot flashes Gabapentin — helps both hot flashes and sleep Supplements (Modest Evidence) Remifemin (black cohosh) — most studied herbal option Equelle (S-equol) — soy-derived, some good research behind it Sleep-Specific Help CBT-I (Cognitive Behavioral Therapy for Insomnia) — apps like Sleepio are highly effective Cooling products like ChiliSleep/OOLACOOL mattress pads can help physically My Strong Recommendation See a menopause-certified physician (find one at menopause.org) — they can personalize your treatment. Would you like more detail on any of these options?
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