"It's all in your head"; "All your tests are normal"; "There's nothing more to be done"; "Get more rest"; "Exercise more"; etc., etc.
Women are usually given only estrogen for hot flashes, but they can be caused by low progesterone too, with normal to high estrogen. Progesterone is not only for the health of the uterus; it is also for the nervous system (fuzzy thinking, mood swings, depression, sleep.) Progesterone opposes estrogen's ability to stimulate growth of estrogen-sensitive tissues so that estrogen doesn't act too much like a growth hormone. Thus, progesterone has an estrogen balancing, cancer risk reducing effect. Furthermore, many of my estrogen-dominant patients have headaches, joint pain, water retention, and weight gain.
Progesterone often resolves all the above, so it is the unopposed estrogen (estradiol mainly) that causes so much discomfort. Did you know that stress reduces progesterone production by the ovaries but has no effect on estrogen? So, stress aggravates estrogen dominance.
What if you have no ovaries? Progesterone is made almost entirely by the ovaries, whereas estrogen can easily be produced by fat, and to a lesser extent, by the adrenal glands. Accurate testing reveals that most of my post-menopausal women patients actually have plenty of estrogen well into menopause and older ages.
Antidepressants are for raising neurotransmitter levels to normal (the "happy hormones" serotonin, norepinephrine, and dopamine). Why use them for hot flashes when balancing estrogen and progesterone works? The exception to this is the woman with a history of estrogen or progesterone sensitive cancer.
PMS is a progesterone deficiency/estrogen dominance situation. Progesterone in precise, individualized doses, cures PMS. Antidepressants can help some of the symptoms of PMS, but I prefer to address the true underlying cause by balancing estrogen with progesterone and leaving the antidepressants for neurotransmitter deficiencies. On the other hand, there is no reason to treat chronic depression and anxiety with high progesterone doses just because it helps. Again, my preference is to treat the actual deficiency with the proper hormone and leave the symptom-reducing bandaids for the crises that require them.
This whole issue is about who specializes in treating crises with surgery and powerful drugs, and who specializes in treating imbalances that aren't necessarily crises. These two areas of healthcare are gradually merging, integrating with one another, and becoming the new model of healthcare, Integrative Medicine.