Options for Hot Flash Relief
Up to 80 percent of U.S. women going through menopause experience hot flashes, or sudden feelings of intense heat. Self-care measures may help, especially for mild symptoms. Here are a few remedies to try now for hot flash relief, along with alternatives if hot flashes become difficult to manage.
First, try dressing in layers, with a porous fabric like cotton next to your skin (remove the top layer if a flash starts). Sleep on cotton sheets and keep your bedroom cool. Avoid alcohol, highly spiced foods, or anything else that seems to provoke hot flashes. If you are overweight, losing weight—specifically body fat rather than lean mass—may help lessen hot flashes and night sweating.
Non-drug therapies including paced breathing, cognitive behavioral therapy, and acupuncture may also bring relief, especially if you combine one or more of these approaches.
Medical treatment options
When hot flashes become truly disruptive, however, many women seek medical treatment. Hormone therapy—low doses of estrogen taken alone or in combination with progestin—has been the conventional approach to hot flash relief and stopping night sweats. Though hormone therapy is no longer recommended long term, it is safe in the short term and can be considered for relieving severe menopausal symptoms.
For women who seek alternatives to conventional hormone therapy, other prescription drugs, as well as dietary supplements, are often recommended. Here’s what we know—and what we don’t.
• Antidepressants. A large study in the Journal of the American Medical Association found that escitalopram (Lexapro)—a selective serotonin reuptake inhibitor (SSRI)—reduced the frequency and severity of hot flashes, compared to a placebo. Other antidepressants, such as fluoxetine (Prozac), paroxetine (Paxil), and venlafaxine (Effexor), are also sometimes used, in small doses. While they help many women, they are not as effective overall as hormone therapy in reducing hot flashes, and responses can be highly variable. In June 2013, despite rejection by a Food and Drug Administration advisory board, which cited only marginal benefit from the drug, the FDA approved Brisdelle (a low-dose version of paroxetine) to treat moderate to severe hot flashes (vasomotor symptoms) associated with menopause.
• Other nonhormonal drugs. Clonidine (Catepres, a hypertension drug) and gabapentin (Neurontin, used for epilepsy and shingles pain) may be somewhat effective. In one study, gabapentin decreased hot flashes by 51 percent, compared with 26 percent for the placebo. But because there are few studies testing these drugs for hot flashes, and because they are not as good as estrogen, their use should probably be limited to women with severe hot flashes who can’t or don’t want to take hormones.
• Isoflavone supplements. Evidence is mixed for these estrogen-like plant compounds, often derived from soy or red clover. A review of 19 studies in the journal Menopause concluded that soy supplements, particularly those containing the isoflavone genistein, reduced the frequency and severity of hot flashes. And an Australian review of studies several years ago concluded that isoflavones may have a small to moderate benefit, but it also noted a strong placebo effect. Meanwhile, a review from the independent Cochrane Collaboration concluded that there is no evidence that plant estrogens, overall, are effective. In one study, women who took soy tablets had more hot flashes than those randomized to take a placebo. The long-term safety of isoflavone supplements is unknown, particularly regarding breast cancer risk. If you want to try soy as a hot flash remedy, try eating a serving or two of soy foods a day instead of taking a supplement.
• Black cohosh. Though this herb (found in Remifemin and other products) has been much studied, the evidence is still slim. Most studies have not been well designed and have had inconsistent results. A 2010 Canadian analysis of nine studies found black cohosh beneficial in six of them. But some studies have shown it to be no better—or even less effective—than a placebo. Despite concerns that black cohosh may cause liver damage, no significant adverse effects were seen in a 2009 study in Menopause. Still, if you want to try it, tell your doctor so he or she can monitor your liver function.
• Other dietary supplements. Most other proposed remedies—including ginseng, evening primrose oil, ginkgo, flaxseed, dong quai, valerian, vitamin E, wild yam, and melatonin—have little or no published research to back their use, and some may have undesirable side effects or be harmful. A well-designed study in Menopause in 2010 found that St. John’s wort decreased hot flashes after eight weeks, but some other studies have shown no benefit from this “herbal antidepressant.” Keep in mind that supplements are not well regulated by the FDA. There is no guarantee that the product is safe or that the bottle contains what it’s supposed to. If you try any supplement, tell your doctor, since many of them can interfere with medication.