The present invention relates generally to methods for treating hot flashes by administering formulations for transdermal or transmucosal administration of estrogen. The formulations of the invention are effective at treating hot flashes at surprisingly low daily doses, preferably the lowest effective dose of estrogen to treat hot flashes, e.g., about 0.45 to about 0.6 mg of estrogen per day. The amount of estrogen which is administered produces an estimated nominal daily estrogen dose in a subject undergoing treatment of from about 10 to about 15 micrograms, and a serum estradiol level of between about 25 pg/ml to about 50 pg/ml. The preferred formulations are substantially free of malodorous, and irritation causing long-chain fatty alcohols, long-chain fatty acids, and long-chain fatty esters.
