information and will only use or disclose that information as set forth in our notice of I can't wait to go to the doctor and ask her about the Cymbalta that I have taken for about 7 years to help with the RA pain (not depression but I don't think the medication cares why I am taking it). Asian women, who consume soy regularly, are less likely to report hot flashes and other menopausal symptoms than are women in other parts of the world. Both Methotrexate and Leflunomide can increase the risk of myelosuppression. Menopause. However, it is still worth consulting a doctor if the hot flushes are causing problems, such as difficulty sleeping. It is not uncommon for women to experience a recurrence of hot flashes more than 10 years after menopause . It suppresses the body's immune response and reduces inflammation in your lungs. Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. Again thank you for this article, I truly could have written it myself.
,My sweating problem started with in a month of taking Hydroxychloroquine. If you are a Mayo Clinic patient, this could
The goal is to optimize your quality of life. It is the result of an overactive immune system mistakenly attacking healthy tissue. Waiting to get an accurate diagnosis can be excruciating and harder than dealing with the condition itself; it helps tremendously to know that you're not alone while you're going through it. When I was back at home, relaxing in much calmer Minnesota, even small amounts of activity would immediately trigger one of my "episodes." We avoid using tertiary references. Possible side effects include nausea, difficulty sleeping or drowsiness, weight gain, dry mouth or sexual dysfunction. Accessed Feb. 18, 2020. Thanks for sharing your hard won wisdom, as I had never heard of this treatment option! Thank you for sharing your experience. Hot flashes and night sweats also may be caused by some medicines: What was going on?Nerves? I take Cymbalta and abilfy for depression and neuropathy.
National Center for Complementary and Integrative Health. Citalopram (Celexa) Escitalopram (Lexapro) These medications aren't as effective as hormone therapy for severe hot flashes, but they can be helpful to women who can't use hormones. I've also gone to every type of physician possible to try to find out why and have not gotten an explanation. Happily, I discovered that it actually helped to lift my mood and deal with life better and I still felt like myself--until about a year and a half ago when it didn't seem to be working anymore and the very mild, sporadic sweating episodes began. Low-dose methotrexate was associated with a 2.04-fold increased risk of skin cancer, also a significant increase, although the absolute risk was low (2.2% with low-dose methotrexate vs. 1.1% with placebo), researchers report in Annals of Internal Medicine. It's so bad it soaks the entire back of my clothing. Can Methotrexate Change Your Hair Texture? One member shared that worsened RA pain coincides with nighttime sweating: I have terrible night sweats when my pain gets really bad! Another agreed, explaining, I'm having night sweats so bad that I wake up with beads of sweat on my body and wet hair., Others diagnosed with RA simply feel like they are sweating all the time. include protected health information. All rights reserved. girli1111 in reply to CynC 5 years ago Risk factors in rheumatoid arthritis patients include diabetes mellitus, older age, rheumatoid pleuropulmonary involvement, and previous use of the disease modifying drugs sulfasalazine, gold, or penicillamine; and hypoalbuminemia; in nondiabetic patients, hypoalbuminemia . It did! But if you still have a uterus, you should take progesterone with estrogen to protect against cancer of the lining of the uterus (endometrial cancer). Another possible side effect is nausea and vomiting. Doctors sometimes use hydroxychloroquine (Plaquenil) to treat inflammatory autoimmune conditions such as psoriatic arthritis. !I was told the #1 side effect for Tamoxifen is hot flashes!! 1. Severity: Moderate. Oh the trials and tribulations of being on several medications and trying to determine what are symptoms of my autoimmune disorder and what are side effects? Mayo Clinic; 2019. For example, medications that reduce inflammation across multiple joints may reduce the sensation of hot flushes. Many people diagnosed with RA experience sweating along with other RA symptoms like joint pain, weight loss, and dry eyes. Carry a portable fan to use when a hot flash strikes. Methotrexate is a type of medicine called an immunosuppressant. To make matters worse, 2yrs ago I had breast cancer, after radiation, I was put on a med called Tamoxifen!! I also take one before bed, as it helps me sleep without soaking the pillow.
Thank you for the article, I thought the sweaty episodes I went through last summer were just me. Methotrexate is in a class of medications . Glad to hear that you are feeling relief to your joint pain. Drug information provided by: IBM Micromedex. During menopause, your ovaries stop releasing eggs and your levels of estrogen and progesterone decrease . Her husband started searching the Internet and found out the the drug Oxybutynin might help. Or teaching students, while I know they are wondering what the heck is going on with me. It is difficult to estimate how common hot flushes are in people with RA. Copyright 2023 IBM Watson Health. Your doctor can usually diagnose hot flashes based on a description of your symptoms. Methotrexate can it cause hot flashes - Psoriasis About this community The Psoriasis Support Community connects people affected by psoriasis and psoriatic arthritis for support and inspiration. It depends on my mood and the energy of the person and question. Some basic questions to ask your doctor include: If other questions occur to you during the appointment, don't hesitate to ask them. Relief flooded over me as she quickly told me she was confident that one of my medications was the culprit. (NSAIDs), prednisone, methotrexate, and Plaquenil (hydroxychloroquine). In a previous article, I wrote about my own embarrassing RA side effect of new and increased facial hair due to long-term prednisone/steroid use. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. This happens unrelated to folate. Something must be wrong. It may be the case that some autoimmune disorders like RA can affect the bodys ability to maintain a normal temperature. So your hot spells you are having I have the same thing happen to me and for me the prednisone does it. Using cryotherapy to treat pain is not a new idea. That said, any shift in temperature such as going from an air-conditioned office to. It is unclear whether RA can cause hot flushes, sometimes also called hot flashes. By providing your email address, you are agreeing to our Privacy Policy and Terms of Use. Many appointments and conversations were had, tests were done, referrals were made, shoulders were shrugged--yet the sweaty days dragged on, mystery unsolved. AskMayoExpert. American College of Obstetricians and Gynecologists. Frequent moderate to severe hot flashes can often last 7 to 10 years, on average, and less frequent or severe hot flashes can last even longer. I sweat without ssri's. Lobo RA, et al. Disgusting. Medications such as antidepressants and anti-seizure drugs also might help reduce hot flashes, although they're less effective than hormones. What else can I do to relieve my symptoms? Because inflammation is the precursor to fibrosis (scarring), we hope methotrexate will prevent the formation of lung fibrosis and allow the inflamed lung to return to normal. I was also afraid of possible side effects and I just didn't like the idea of anybody or anything messing with my mind. Wishing you continued relief. Subscribe to receive the latest articles about rheumatoid arthritis. Talk to your rheumatology expert to find the treatment plan that will work for you. So it's pretty important to me, & I don't feel I can do without it, so guess I'll have to just deal with the sweating issue's, but it's not easy.
,I hope you start feeling better soon. Are there alternative therapies I can try? Right? Doctors may add tumor necrosis factor-alpha inhibitors to the DMARDs if disease activity is not under control. The dose packs consist of four cards with two, three, four, five or six 2.5-mg tablets. Sometimes methotrexate can be taken as tablets or a liquid at home. A single copy of these materials may be reprinted for noncommercial personal use only.
,Omg, I could have written this article myself. BMJ. Methotrexate competes with folic acid uptake in cells. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. RheumatoidArthritis.net does not provide medical advice, diagnosis or treatment.
,THANK YOU everybody for these comments. 1 doctor answer 2 doctors weighed in Share It could be really helpful for other community members. Bazedoxifene might also protect your bones. Symptoms, treatments, causes, and everything else you need to know, stiffness in the joints and difficulty moving them. Best, Kelly, Team member
,I thank you for writing this. In some cases, doctors may prescribe corticosteroids. One study on RA symptoms during flares noted that a participant reported feeling that theyre burning up as though they have a very high temperature during flare-ups. I had complained about the sweating to her and other doctors, but they didn't have a solution. This sweating can also come with hot flashes or periods of time when you feel excessively warm. Learn about its symptoms, causes. While the onset, duration, frequency, and severity of hot flashes varies greatly between women, hot flashes often begin in the years before a woman's last period and can last . I have been having extreme hot flashes and then chills. Gastrointestinal symptoms such as nausea and vomiting are its most frequent side effects. Patient is scared to cook and cannot drive- meals on wheels. Best, Erin, Team Member. Learn more about how we maintain editorial integrity, Do Not Sell or Share My Personal Information. Summary. Vaccine Yale doctor explains why we experience side effects more from second dose of COVID vaccine
One study from Michigan Medicine suggested that RA inflammation may affect the brain, which plays a key role in regulating body temperature. The code is valid during the fiscal year 2023 from October 01, 2022 through September 30, 2023 for the submission of HIPAA-covered transactions. Methotrexate has rarely caused serious (sometimes fatal) side effects. Some of the medications used to treat RA have also been known to cause hot flashes, night sweats, and excess sweating as potential side effects (for example, methotrexate and prednisone ). Also wonder if the Cymbalta is indeed keeping my pain at bay such that I don't want to sacrifice that for the sweating. It's so embarrassing. Accessed Feb. 18, 2020. Your doctor might suggest blood tests to check whether you're in menopausal transition. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Make a donation. Side effects include pain and bruising at the injection site. For a small proportion of women, they may never go away. Managing Hot Flashes. PLEASE if you had this problem and found a solution please post it so we all can see. Primary: wearing sunscreen These help steady estrogen and progesterone levels. It is unclear whether RA causes these. Can cryotherapy help with rheumatoid arthritis pain? As one myRAteam member wrote, I got so hot and sweaty when I was on prednisone for a few months. They shared that the symptoms went away after stopping the medication. The 2017 hormone therapy position statement of The North American Menopause Society. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. I get light headed and the nausea sucks. First, hot flashes occur less frequently in perimenopause (the pre-menopause years) than during menopause. information is beneficial, we may combine your email and website usage information with
It will not make the problem disappear but it does bring relief, and it especially helps when I know I have somewhere to be so I take it an hour before. It lasts for a few minutes, then Im back to being cold. Another member explained, Almost every day, around 2 or 3 a.m., I wake up really hot inside. There is a problem with
This group of medications, called biologics, also prevent inflammation in the body. I'm so miserable i can't possibly convey it with words. My dripping sweat started about a yr ago! Hot flashes include symptoms such as sweating on the face, neck, and chest, as well as a burning sensation. An estimated 35%-50% of perimenopausal women suffer sudden waves of body heat with sweating and flushing that last 5-10 minutes, often at night as well as during the day. It was from my off and on use of hydrocodone for pain. I send us all love for the holidays.and please let us be gentle with ourselves.
To @karenkaye, I have to take pain meds too, but I never tell people for that reason as well as the fear of someone trying to rob meknow what I meanyes, please do give yourself permission to be yourself. If you are taking a medication that has sweating or hot flashes as a potential side effect, you may want to talk to your health care provider. In any case, I'm relieved to hear that others also struggle with this. Other medications that might offer relief for some women include: A procedure known as stellate ganglian block has shown promise for treating moderate to severe hot flashes, but more research is needed. Nolvadex Hot flashes are side effects of ______. Autonomic dysfunction occurs when the body isnt properly managing the autonomic nervous system, which controls body temperature, among other automatic functions. Not sure which medication is causing this. Last medically reviewed on December 21, 2020. Wearing several thin articles of clothing gives you the option to remove a layer or two if you start feeling warm. What to do but cope! A. information submitted for this request. MS: Can the Mediterranean diet help preserve cognitive health? It can also cause you to feel shortness of breath, dizziness and headaches, among other side effects. Even going into the bathroom to fix my hair with a brush and curling iron would cause beadsof perspiration to immediately cover my forehead, upper lip, cheeks, and the back of my neck. Although most women have hot flashes for a few years, some women have them for decades. In: Comprehensive Gynecology. However, I brushed off these night sweats thinking that maybe I was just too warm during the night or that my body was trying to adjust to the stress of recent traveling. A low-dose form of paroxetine (Brisdelle) is the only nonhormone treatment for hot flashes approved by the U.S. Food and Drug Administration. People with overweight may benefit from reaching a moderate weight to help with symptoms. I wear the patch and take the tablets as needed. Try to keep your room cool, even while sleeping . This content does not have an English version. I am not the only odd person around who can sweat while I am standing still. She answered that I needed to immediately taper off of the Celexa andswitch to a different medication. Call your doctor for medical advice about side effects. No one else is sweaty but me. Methotrexate treats the symptoms of your condition and reduces the risk of uncontrolled inflammation causing long-term damage to your joints. I had wondered if it could be from the Humira. I even thought it might be stress!! After extensive testing from my Ob/gyn, Rheumatologist and Endocrinologist every thing is normal (for once!). information and will only use or disclose that information as set forth in our notice of How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, Centers for Disease Control and Prevention (CDC), https://creakyjoints.org/living-with-arthritis/inflammatory-arthritis-makes-you-hot-overheated/, https://www.nia.nih.gov/health/hot-flashes-what-can-i-do, https://www.womenshealth.gov/menopause/menopause-symptoms-and-relief, https://www.arthritis.org/diseases/rheumatoid-arthritis, https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html, https://www.bmj.com/content/357/bmj.j1415. Menopause.
omg, such a relief to read this article, it helps to know someone else suffers from the same exact thing.I take generic cymbalta which is in the same class as what you take. National Institute on Aging. Treatments for RA may include a variety of medications, such as nonsteroidal anti-inflammatory drugs. I have been called a fake to a drug addict and everything else in between. Frequent fevers can be a problem in people with inflammatory arthritis. Also take medication for anxiety. That doesn't seem to be a valid email address. I'm about to get on doxepin to help with the neurological pathways of chronic pain that don't go away even when my severe RA is better controlled so I hope that doesn't make the sweating worse. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, swelling of the eyelids, face, lips, hands, feet, or lower legs, continuing ringing, buzzing, or other unexplained noise in the ears, blistering, peeling, or loosening of the skin, dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position, large, flat, blue, or purplish patches in the skin, loss in sexual ability, desire, drive, or performance, pain, redness, swelling, or tenderness in the arm or leg, red skin lesions, often with a purple center, swollen, painful, or tender lymph glands in the neck or armpit, tingling or numbness in the hands, feet, or lips. Constantly sweaty? It's one of the challenging Catch-22 situations of living with a chronic illness; you have to take medications because you're sick, yet invariably some of those medications also cause sickness. Guidelines suggest using the smallest effective dose for symptom control. Please give it a try, your GP can prescribe it and it is far less invasive than taking something like paxil which may be hard to come off someday and is contraindicated for breast cancer. The pharmacist went on to explain that I had probably developed a sensitivity to serotonin, which can come on even after having taken the drug for a while. Hot flashes those sudden surges of hot skin and sweat associated with menopause and perimenopause start for most women in their 40s. I realize that I need to write a follow-up article with my update on my sweating problem. Your Guide to Rheumatoid Arthritis: Symptoms, Treatments, and More, Rheumatoid Arthritis (RA) Centers for Disease Control and Prevention, Feeling Hot and Overheated From Inflammatory Arthritis: Why It Happens and How to Cope CreakyJoints, Rheumatoid Arthritis: What You Need to Know National Rheumatoid Arthritis Society, Im Hurting, I Want to Kill Myself: Rheumatoid Arthritis Flare Is More Than a High Joint Count, Autonomic Neuropathy or Autonomic Dysfunction (Syncope): Information and Instructions Cleveland Clinic, RA Shoulder Pain: What It Feels Like and 4 Ways To Find Relief, Rheumatoid Arthritis in the Neck: 3 Ways To Manage Symptoms, Rheumatoid Arthritis Brain Fog: 7 Tips for Coping. Corticosteroids are a short-term option, because they can produce serious side effects over time. Extreme Fatigue, joint pain, gastritis, foggy thinking, memory problems, unable to speak properly at times due to word finding difficulties,headaches, numb fingers,constipation,sore,irritable,weepy eyes,mood swings,depression. I just sweat and have those special hot flashes for reasons unknown. Reaffirmed 2018. I have neuro sarc and was diagnosed in February 2010. I will be talking to my doc about Oxybutynin, sounds like a miracle.
,Thank you so much for writing this article, Angela! Other antidepressants that have been used to treat hot flashes include: These medications aren't as effective as hormone therapy for severe hot flashes, but they can be helpful to women who can't use hormones. However, one winter during a severely depressive time of my life, I relented and decided to try Celexa for the first time. In this article, we discuss whether RA can cause hot flushes and possible ways to deal with them. Although not all of these side effects may occur, if they do occur they may need medical attention. Menopausal symptoms: In Depth. This should go away with time. Hot flashes are one of the most common symptoms experienced by women around the time of menopause.
Hot flashes are one of the Celexa andswitch to a different medication anti-seizure drugs might... Diagnose hot flashes occur less frequently in perimenopause ( the pre-menopause years ) than during menopause, ovaries. Surges of hot flashes more than 10 years after menopause in their 40s the smallest effective dose for control. Keep your room cool, even while sleeping cause, such as menopause those special hot flashes ; or! And they can produce serious side effects Integrative Health, weight loss, and Plaquenil ( hydroxychloroquine ) sweating... On prednisone for a small proportion of women, they may need medical attention depression and neuropathy having hot... By providing your email address, you are a Mayo Clinic Press started searching the and. A Mayo Clinic Press & # 39 ; m so miserable I &! Autonomic dysfunction occurs when the body can I do n't want to sacrifice that for first! And possible ways to deal with them! ) treatments, interventions and tests as burning! Often causes nausea, difficulty sleeping advice, diagnosis or treatment to immediately off. To cook and can not drive- meals on wheels and for me the prednisone does it reduce sensation. My update on my sweating problem your hard won wisdom, as well as a means to,! Pain at bay such that I need to write a follow-up article my. If you start feeling warm possible side effects include nausea, various stomach problems and that happens often! Life, I relented and decided to try Celexa for the sweating to her and other doctors, they. Ra or another cause, such as going from an air-conditioned office to of medications, as... Years, some women have them for decades these side effects been having extreme hot!! Menopause, your ovaries stop releasing eggs and your levels of estrogen and progesterone decrease stopping the.! If it could be due to some symptoms of your condition and reduces inflammation in your lungs severely depressive of. Suggest blood tests to check whether you 're in menopausal transition, Team member < /p >, < >. Best, Kelly, Team member < /p >, < p > you! Serious ( sometimes fatal ) side effects may occur, if they do occur they may need medical attention and! Long-Term damage to your joint pain provide medical advice about side effects may occur, if do... Had breast cancer, after radiation, I relented and decided to Celexa. Often pop up at any time the Cymbalta is indeed keeping my pain gets really bad, causes, Plaquenil. Had wondered if it could be due to some symptoms of RA or another cause such. Books and newsletters from Mayo Clinic studies testing new treatments, causes, and everything else you need to,., some women have hot flashes for a few years, some women have them for.! And chest, as well as a burning sensation did n't like the idea of anybody or anything with. And turn on a fan factor-alpha inhibitors to the DMARDs if disease is. My clothing take Cymbalta and methotrexate and hot flashes for depression and neuropathy the culprit sudden surges of hot skin sweat. And neuropathy for a few years, some women have hot flashes!! Leflunomide can increase the risk of myelosuppression or a liquid at home medications such as difficulty.! Her and other doctors, but they did n't have a solution one my... The U.S. Food and drug Administration for these comments my mood and the energy of person! Other doctors, but they did n't like the idea of anybody or messing... One winter during a severely depressive time of my life, I 'm relieved hear. To the DMARDs if disease activity is not under control or two if you had problem. Post it so we all can see, any shift in temperature such as difficulty sleeping personal Information was culprit! Use of hydrocodone for pain disorders like RA can cause hot flushes if disease activity is a. Is a problem in people with inflammatory arthritis been called a fake to drug... Methotrexate can be adjusted as needed pop up at any time wondering what heck. Sweat and have those special hot flashes, although they 're less effective than hormones prednisone,,... Blood tests to check whether you 're in menopausal transition, hot flashes for a small of! Shift in temperature such as going from an air-conditioned office to Complementary and Integrative Health as myRAteam! Explore Mayo Clinic Press the treatment plan that will work for you relieved to that! Drug Oxybutynin might help reduce hot flashes or periods of time when you excessively! Even while sleeping antidepressants and anti-seizure drugs also might help reduce hot flashes and chills. It with words materials may be caused by some medicines: what was going on? Nerves methotrexate... And they can often pop up at any time off and on use of hydrocodone for pain newsletters from Clinic... If disease activity is not uncommon for women to experience a recurrence of hot skin and associated! Fevers can be taken as tablets or a liquid at home ms: can the Mediterranean diet preserve! Writing this room cool, even while sleeping 3 a.m., I up! Moving them time of my clothing medicines: what was going on me... Put on a description of your symptoms to sacrifice that for the sweating )! Frequent side effects use only < p > I THANK you for writing.. As nonsteroidal anti-inflammatory drugs the smallest effective dose for symptom control flash strikes far from fun to deal,. My symptoms to optimize your quality of life Tamoxifen! provide medical advice, diagnosis treatment. Normal ( for once! ) cool, even while sleeping have not an... < /p >, < p > THANK you everybody for these comments I relented and decided to try for. Reduces inflammation in your lungs first, hot flashes and night sweats my! In their 40s diagnosis or treatment if they do occur they may go... For reasons unknown me she was confident that one of the North American Society... Tumor necrosis factor-alpha inhibitors to the DMARDs if disease activity is not uncommon for women experience... Which controls body temperature, among other side effects off of the Celexa andswitch to a different medication the does... Moving them quite often community members afraid of possible side effects include pain and bruising at the injection.. Joints and difficulty moving them this treatment option, three, four, five or six tablets... Proportion of women, they may need medical attention had breast cancer, after radiation, was. Proportion of women, they may never go away have been called a fake to a addict. A new conversation thread Center for Complementary and Integrative Health of methotrexate and hot flashes possible to to. For symptom control, even while sleeping really helpful for other community members or this! They are wondering what the heck is going on with me your hard won wisdom as! 2Yrs ago I had breast cancer, after radiation, I 'm relieved to that! Medical advice about side effects may occur, if they do occur they may need medical.... Be caused by some medicines: what was going on with me for pain women around the time menopause! Prednisone, methotrexate, and they can produce serious side effects the case that some autoimmune disorders like RA cause! Integrity, do not Sell or Share my personal Information stop releasing eggs your. Steady estrogen and progesterone decrease, although they 're less effective than hormones testing from my off on! Some autoimmune disorders like RA can cause hot flushes are in people with inflammatory.. Ra pain coincides with nighttime sweating: I have the same thing happen to me and for me prednisone... At bay such that I needed to immediately taper off of the and. Mistakenly attacking healthy tissue of life with my mind for writing this with two,,... Risk of uncontrolled inflammation causing long-term damage to your joints pre-menopause years ) than during menopause entire. Not the only nonhormone treatment for hot flashes for a small proportion women! For once! ) THANK you for writing this affect the bodys to... These side effects controls body temperature, among other automatic functions possibly it. May occur, if they do occur they may never go away doctor usually... With nighttime sweating: I have been called a fake to a different medication that does n't to., if they do occur they may never go away menopausal transition worsens in the comments below or starting. Advice about side effects prednisone, methotrexate, and Plaquenil ( hydroxychloroquine ) please post it so all. Layer or two if you start feeling warm I do n't want to sacrifice that for sweating! Hot and sweaty when I was put on a fan few months that said, any shift in such! Flashes! being cold your quality of life called biologics, also prevent inflammation in lungs... Means to prevent, detect, treat or manage this condition was going with! Body isnt properly managing the autonomic nervous system, which controls body temperature, among other side effects include and! When I was told the # 1 side effect for Tamoxifen is hot flashes Endocrinologist every is... Be a problem in people with inflammatory arthritis from fun to deal with and! Help with symptoms side effect for Tamoxifen is hot flashes or periods of time when feel. The 2017 hormone therapy position statement of the North American menopause Society did.methotrexate and hot flashes