Treating hot flashes without hormones: What works, what doesn't?

The intense heat, sweating and rapid heartbeat synonymous with hot flashes can range from a tolerable annoyance to a debilitating condition for the three out of four women who report having them while going through menopause.

While hormonal treatments are available, some women cannot use them for medical reasons or choose not to. To find relief, some 50 to 80 percent of women approaching menopause try nonhormonal therapies, according to the North American Menopause Society (NAMS), a nonprofit association of health care professionals in the field.

But scientific data on which of these treatments actually work is sparse, so women often end up taking a trial-and-error approach. "Many women try one thing after another, and it is months before they stumble upon something that truly works for them," Janet S. Carpenter, PhD, RN, said in a statement.

Carpenter headed a panel from the NAMS that analyzed the available studies to assess which treatments work and which don't. Click through to see the panel's recommendations.

Cognitive behavioral therapy

The researchers found evidence that certain cognitive behavioral therapy techniques were effective in reducing women's ratings of how bothered they were by hot flashes, but not the actual number of hot flashes. These therapies include practicing relaxation techniques, adopting good sleep hygiene, and learning to take a positive, healthy approach to menopause challenges.

The panel also found limited evidence to suggest that clinical hypnosis may be beneficial in managing hot flashes.

Cooling down

Sitting in front of a fan or placing an ice pack under your pillow at night might seem like logical ways to beat hot flashes. But the panel actually found no scientific evidence that such interventions are effective for treatment.

“Trigger” foods?

While women are often advised to avoid hot flash "triggers" such as alcohol, spicy foods and hot foods or liquids, the researchers found no clinical trials that have actually studied the effects of these presumed triggers. The Melbourne Women's Midlife Health Project also found no significant association between alcohol intake and hot flashes.

Exercise and weight loss

Regular aerobic exercise has been associated with a reduction in hot flashes in some observational studies, but others showed no relationship between the two. Furthermore, vigorous exercise may trigger hot flashes in some symptomatic women. The panel also found no evidence that practicing yoga reduced hot flashes.

While these techniques certainly have other health benefits, including reducing the risk of obesity, heart disease and type 2 diabetes, the panel does not recommend exercise or yoga for treatment of hot flashes.

And while some studies suggest weight loss might be associated with a decrease in hot flashes, the review found that the evidence to support the relationship isn't very strong.

Soy foods and soy extracts

In Asian countries where soy is a dietary staple, women tend to have fewer hot flashes than women in the United States. But while some studies found evidence that soy foods help reduce hot flashes during menopause, others have shown no benefits at all.

A soy derivative called S-equol is currently being studied for women who do not have the ability to metabolize some of the compounds found in soy protein, but the panel says additional research is needed to determine whether the supplement is effective.

Prescription medications

The panel found that some nonhormonal prescription medications are beneficial in reducing hot flashes, though they may not offer as much relief as hormones. Paroxetine, a selective serotonin reuptake inhibitor and the one FDA-approved nonhormonal therapy for hot flashes, offers mild to moderate improvements, the study authors found.

Other medications shown to be helpful include serotonin-norepinephrine reuptake inhibitors (SNRIs, such as venlafaxine), the gabapentinoids (gabapentin and pregabalin) and clonidine.

The panel recommends these medications be used at the lowest doses first, then gradually increase the dose as tolerated. Choosing which medication should be used depends on the individual; the decision should be made after weighing the benefits and risks with a doctor.

Over-the-counter supplements

While claims have been made that some over-the-counter supplements and herbal therapies -- including black cohosh, dong quai, evening primrose, flaxseed, maca, omega-3s, pollen extract and vitamins -- help beat hot flashes, the panel found that these products are unlikely to help and therefore does not recommend them for treatment of hot flashes.

Acupuncture

Acupuncture, practiced in traditional Chinese medicine, involves inserting tiny needles at specific points on the body. Some studies suggested it may help against hot flashes; however, in other research, it proved no more effective than a sham procedure that placed needles at random. The panel concluded that there is not currently enough evidence to recommend acupuncture for treating hot flashes.