Menopause: Non-Hormonal Treatment & Relief for Hot Flashes
Hormone therapy is the most effective therapy for hot flashes. However, other non-hormonal options are available for women who are suffering from symptoms, but are not yet ready to consider hormone therapy. Some women are not appropriate candidates for hormone therapy, such as those have been recently treated for breast cancer. It is important to remember that when used appropriately, hormone therapy can be a safe and effective option for many women. Here we will review non-hormonal treatment options for women.
Knowing the triggers of hot flashes
Hot flashes may be precipitated by hot weather, smoking, caffeine, spicy foods, alcohol, tight clothing, heat and stress. Identify and avoid your hot flash "triggers." Some women notice hot flashes when they eat a lot of sugar. Exercising in warm temperatures might make hot flashes worse.
Avoiding caffeine, spicy foods, and alcohol can help lessen both the number and severity of hot flashes. Many women try to incorporate more plant estrogens into their diet. Plant estrogens, such as isoflavones, are thought to have weak estrogen-like effects that may reduce hot flashes. They may work in the body like a weak form of estrogen. Examples of plant estrogens include: soybeans, chickpeas, lentils, flaxseed, grains, beans, fruits, red clover and vegetables. In general, soybeans, chickpeas, and lentils are considered to have the most powerful plant estrogens, though their effect is much less than that of human estrogen. Try to choose natural foods rather than supplements. Also remember that only crushed or ground forms of flaxseed are likely to help (as compared to the whole seed or seed oil forms).
What foods have high amounts of isoflavones?
Food: Soybeans, green, raw Isoflavone
Amount (Mg) In Food (100g): 151.17
Food: Soy flour (textured) Isoflavone
Amount (Mg) In Food (100g): 148.61
Food: Soybeans, dry roasted Isoflavone
Amount (Mg) In Food (100g): 128.35
Food: Instant beverage soy, powder, not reconstituted Isoflavone
Amount (Mg) In Food (100g): 109.51
Food: Miso soup mix, dry Isoflavone
Amount (Mg) In Food (100g): 60.39
Food: Soybean chips Isoflavone
Amount (Mg) In Food (100g): 54.16
Food: Tempeh, cooked Isoflavone
Amount (Mg) In Food (100g): 53.00
Food: Soybean curd cheese Isoflavone
Amount (Mg) In Food (100g): 28.20
Food: Tofu, silken Isoflavone
Amount (Mg) In Food (100g): 27.91
Food: Tofu, yogurt Isoflavone
Amount (Mg) In Food (100g): 16.30
Food: Soymilk Isoflavone
Amount (Mg) In Food (100g): 9.65
Reducing the temperature in a room, dressing in layers, and the use of a fan while asleep can be effective ways to help deal with troublesome hot flashes. Women who are overweight tend to have more bothersome hot flashes, therefore weight loss can be helpful. Quitting smoking has a dual importance during menopause. First, smoking contributes to the increased cardiovascular risks of being postmenopausal. Second, smokers tend to experience more hot flashes. Women who lead a sedentary life seem to suffer more from hot flashes; however, it is best to exercise in a cooler environment. Try deep, slow abdominal breathing (6 to 8 breaths per minute). Practice deep breathing for 15 minutes in the morning, 15 minutes in the evening and at the onset of hot flashes. For some women, wearing socks to bed is helpful as it can help to cool core body temperature.
- Keep the bedroom cool to prevent night sweats.
- Avoid using sleeping pills.
- Exercise daily.
- Avoid caffeine and alcohol at night.
- Take a warm bath or shower at bedtime.
- Try milk products at bedtime or during the night (but avoid products that contain caffeine).
Coping with mood swings, fears, and depression
- Find a self-calming skill to practice, such as yoga, meditation or slow, deep breathing.
- Avoid tranquilizers, if possible.
- Engage in a creative outlet that fosters a sense of achievement.
- Stay connected with your family and community; nurture your friendships.
Relieving painful intercourse
Try using a vaginal water-based moisturizing lotion or lubricant during intercourse. These are sold without a prescription near the condoms in most stores. Common names include-Astroglide® and KY liquid® . Avoid Vaseline®, as it may lead to yeast infections.
Prescription and nonprescription remedies
A number of non-hormonal remedies are available for the treatment of hot flashes. Some of these remedies (e.g., black cohosh and soy products) are available over-the-counter but are not FDA-approved. Some prescription medications are used “off label” to help reduce hot flashes. Using a product "off label" means that it is not FDA-approved for the treatment of hot flashes, but is often used because it can be safe and effective for hot flash treatment.
Prescription therapies are considered the more effective non-hormonal treatments. These include:
- Drug: venlafaxine(Effexor®)
- Side Effects: Nausea, change in bowel habits, headache (temporary side effects for most). Elevated blood pressure (at high doses).
- Effectiveness: Effectiveness has been proven in several well-designed studies. One of the safer medications for women taking tamoxifen (no drug interaction).
- Drug: desvenlafaxine(Pristiq®)
- Side Effects: Similar to venlafaxine. Nausea, change in bowel habits, headache (temporary side effects for most). Elevated blood pressure (at high doses)
- Effectiveness: Improvement in hot flashes compared to placebo has been shown. Newer medication compared to venlafaxine, so there are a smaller number of studies are available.
- Drug: fluoxetine (Prozac®)
- Side Effects: Nausea, change in bowel habits, decreased libido, insomnia. Should be avoided in women taking tamoxifen.
- Effectiveness: Improvement in hot flashes has been shown in well-designed studies.
- Drug: paroxetine (Paxil®, Brisdelle®)
- Side Effects: Nausea, change in bowel habits, decreased libido, dry mouth, weight gain (not common). Should be avoided in women taking tamoxifen.
- Effectiveness: Has been FDA-approved to treat hot flashes. Tends to be more effective for sleep in women who are also suffering with insomnia. Improvement in hot flashes has been shown in well-designed studies.
- Drug: escitalopram (Lexapro®)
- Side Effects: Nausea, change in bowel habits, decreased libido, abnormal EKG (not common).
- Effectiveness: Tends to be more effective for sleep in women who are also suffering with insomnia.
- Drug: gabapentin (Neurontin®)
- Side Effects: Fatigue, dizziness, nausea, disorientation, swelling, weight gain.
- Effectiveness: Tends to be more effective for sleep in women who are also suffering with insomnia.
- Drug: clonidine (Catapres®)
- Side Effects: Dry mouth, drowsiness, fatigue, constipation, lowers blood pressure.
- Effectiveness: Relieved hot flashes in some, but not all studies. Less commonly used than some of the other options.
Non-prescription, herbal, over-the-counter therapies:
- Drug: Evening Primrose Oil
- Side Effects: Nausea, diarrhea, headache.
- Effectiveness: Only one well-designed study showing not effective.
- Drug: Black cohosh
- Side Effects: Mild stomach upset. Safe up to 6 months only due to possible estrogen-like effects. Liver toxicity has been reported.
- Effectiveness: Some small, short-term studies have suggested benefits, however most studies do not suggest that it works.
- Drug: Soy (plant estrogen). Also referred to as phytoestrogens.
- Side Effects: Appears safe if consumed in foods. In supplement form, consistency of dose and quality can be a concern. Supplements are not recommended for breast cancer survivors.
- Effectiveness: For the most part, results from clinical studies show that phytoestrogens are not effective for treatment of hot flashes.
- Drug: Acupuncture
- Side Effects: Uncomfortable for some, often costly. Generally well-tolerated, but multiple visits required.
- Effectiveness: Individual trials have reported some benefits, but larger studies have not shown any improvement over placebo procedures. However some women do report benefits with this, so it is possible that more well-designed studies are needed to answer this question.
- Drug: Vitamin E
- Side Effects: 13% increase risk of heart failure. Might increase death rate in those who use high doses for a long time. A higher risk of prostate cancer has also been shown, but applies only to men.
- Effectiveness: One study showing effective. However the improvement seen in this was only one less hot flash per day compared to placebo.
Are the over-the-counter herbal products (botanicals) safe?
While safe when taken in moderate amounts through diet, the consumption of extraordinary amounts of soy and isoflavone supplements may be harmful to women with a history of estrogen-dependent cancer, like breast cancer, and possibly to other women as well.
More research is needed to determine the safety and effectiveness of botanical treatments. For example, ginseng, dong quai, wild yam, progesterone cream, reflexology, and magnetic devices are sold to help menopausal symptoms, but there are no good studies looking at their safety or effectiveness. To make an informed decision about the use of these treatments, be sure to discuss them with your doctor.
Because little is known about many botanicals, the best way to evaluate their safety and effectiveness is to become an educated consumer. Here are some tips to consider when shopping for alternative therapies.
Ask yourself the following questions:
- What is the treatment?
- What does it involve?
- How does it work?
- Why does it work?
- Are there any risks?
- What are the side effects?
- Is it effective? (Ask for evidence or proof)
- How much does it cost?
Once you answer these questions, discuss the therapy with your doctor. Make sure your doctor knows what therapy you are considering in order to discuss possible interactions or side effects with your current treatment.
What are warning signs that a product may not be legitimate?
When trying to determine whether or not a product is what it says it is, one of the elements you may want to look at is how the product is promoted. Be cautious of products promoted through:
- Direct mailings.
- Ads disguised as valid news articles.
- Ads in the back of magazines.
Additional red flags to look for include:
- Big claims: If products claim to be a "cure" for your condition, or gives outrageous claims, be cautious.
- Source: Be wary if the product is only offered through one manufacturer or purchased only through a healthcare provider’s office.
- Ingredients: Make sure all of the active ingredients are listed, and don’t trust "secret formulas."
- Testimonials: Remember that only people who are satisfied with a product give testimonials and that they may be getting paid for their endorsement.