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Diseases & Conditions

Non-Hormonal Interventions for Hot Flashes

Hot flashes

A large number of menopausal women experience hot flashes.

Hot flashes may be precipitated by hot weather, caffeine, spicy foods, alcohol, and stress. Hot flashes are described as a sudden sensation of heat felt in the face, neck, and chest that spreads over the entire body. They are usually accompanied by profuse sweating, followed by a chill. The incidence is greatest in the first two postmenopausal years.

Night sweats are particularly disturbing for menopausal women. Night sweats alter sleep patterns, causing insomnia and irritability.

Non-hormonal interventions

A number of non-hormonal remedies are available for the treatment of hot flashes. Some of these remedies (e.g., vitamin E, 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.

Drug Dosage Side Effects
Evening Primrose Oil Variable Nausea, diarrhea, blood clots. Do not use if seizure history or on blood thinners.
Black cohosh 20 mg twice a day Mild stomach upset. Safe up to 6 mos.
Soy (plant estrogen) Variable Appears safe if consumed in foods.
clonidine (Catapres) 1 mg in a.m. and at bedtime (also in patch form) Dry mouth, drowsiness, fatigue, lowers blood pressure
fluoxetine (Prozac) 20 mg in am Dry mouth, nausea, insomnia.
paroxetine (Paxil) 20 mg at bedtime Fatigue, nausea.
venlafaxine (Effexor) 37.5 mg to 75 mg a day Fatigue, nausea, headache, dry mouth. Elevated blood pressure (at high doses).
gabapentin (Neurontin) Up to 300 mg three times a day Fatigue, dizziness, nausea.
Pristiq (desvenlafaxine) 50 mg once daily Fatigue, nausea, headache, elevated blood pressure

Carroll DG. Nonhormonal Therapies for Hot Flashes in Menopause. Am Fam Physician. 2006;73(3):457-464 Accessed December 29, 2010.

Nelson HD, Vesco KK, Haney E, et al. Nonhormonal Therapies for Menopausal Hot Flashes.JAMA. 2006;295(17):2057-2071. Accessed December 29, 2010.

Tice JA, Grady D. Alternatives to Estrogen for Treatment of Hot Flashes. JAMA. 2006;295(17):2076-2078. Accessed December 29, 2010.

National Center for Complementary and Alternative Medicine. Menopausal Symptoms and CAM. Accessed December 29, 2010.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/4/2010...#10839