Vasomotor symptoms (VMS) of varying intensity and frequency mark transition from premenopausal to perimenopausal period. The management needs to be individualized and shared decision making is advocated. For postmenopausal women with mild VMS lifestyle changes may be of help; while for moderate to severe VMS, systemic MHT shows the best results. In patients without uterus, Estrogen only therapy/ET is preferred; while in patients with uterus, estrogen progestogen therapy EPT is recommended to avoid estrogen-associated endometrial hyperplasia and risk of malignancy. Lowest effective dose of MHT for 3–5 years is usually required for women <60 years or within 10 years of menopause onset with nocontraindications. If MHT is contraindicated or not acceptable, SSRI, SNRI, gabapentin, pregabalin are the alternative options available; and if all are contraindicated, trial of clonidine is suggested. The complementary and alternate therapy are not recommended owing to lack of consistent evidence.
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