Hot flashes occur in over 85% of women during the years around menopause. For many women, hormone therapy may not be an option for turning down the heat from night sweats and hot flashes. After release of the Women’s Health Initiative (WHI) in July 2002, many women abruptly stopped their hormone therapy (HT) while others questioned their safety. Initial results from WHI showed an increase in breast cancer, heart attack, and stroke. With a decade of hindsight we now better know the true risks and benefits of HT. Even with this new evidence showing a major benefit in women starting hormone therapy near the time of menopause (within 10 years), there may still be many women who may not be able to take estrogen. What are some of their options?
Hot flashes, also known as hot flushes are very common. These are commonly known “vasomotor symptoms” in the research and are categorized by severity and frequency:
- Mild: a feeling of warmth in the face, neck and chest.
- Moderate: feeling of warmth with sweating
- Severe: feeling of warmth, with sweating and loss of concentration
What are the options available for women who cannot take HT?
After reviewing numerous studies, I have compiled a list of non-hormonal prescription and non-prescription medications which have been shown to decrease hot flashes. Interestingly, many of these clinical trials were done in women with a history of breast cancer, receiving tamoxifen. Furthermore, many of these trials had a very high placebo rate, i.e. those women not receiving the study medication (placebo pill) showed a high rate of benefit compared to those receiving the actual study medication. This is known as the “placebo effect”. In these studies, the placebo response rate ranged from 18-40%.
Non-hormonal/ Prescription Medications
1) SSRI’s/SSNRI’s : Best results occurred with Venlafaxine ( Effexor) with 63% reduction in hot flashes in patients receiving 75 mg dose, vs. 45% in those receiving lower dose ( 37.5 mg) compared to 20% reduction in placebo group. The next best was Paroxetine (Paxil), followed by Fluoxetine (Prozac).
2) Gabapentin ( Neurontin); 45% decrease in hot flashes vs. 29% placebo, at dose of 300 mg three times a day.
3) Clonidine ( Catapres): very few studies with only short term use, up to 12 weeks, reduces hot flashes by 15-20%., with dose of 0.1 mg/day.
4) Belladonna/ergotamine tartrate/Phenobarbital combination ( Bellergal): decreased hot flashes by 75 % vs. 68% in placebo, dose of one tablet three times a day.
Black Kohash plant
Non-hormonal /Non-prescription Options
1) Black Kohash: This is the most studied and popular herb for treatment of hot flashes. Results of studies show inconsistent results and dosages varied. American College of Ob/Gyn ( ACOG) states that black kohash may be helpful in the short-term ( less than six months) treatment of women with vasomotor symptoms.
2) Soy isoflavones: Studies showed inconsistent results. Some showed significant reduction in women with moderate to severe hot flashes. ACOG recommends that soy and isoflavones be used in the short-term , less than 2 years and that they should be used with caution in women with an estrogen-dependent cancer, given the possible interaction with estrogen (39).
3) Red Clover, Ginseng, Evening Primrose oil, Wild Yam: In clinical trials, no significant difference in hot flash reduction compared to placebo. I have included these because many patients frequently do use these remedies and do find some relief, although for only a short period of time
Take Home Tips:
1) Hot flashes occur very frequently in women around the time of menopause and can significantly affect a woman’s quality of life.
2) A thorough medical history should be taken to rule out other causes for hot flashes, such as thyroid disease.
3) Evaluation of current medications and conditions should be considered with you and your health care provider to determine the best option for you, be it hormonal, or non-hormonal.
4) There are prescription medications available as well as herbal remedies.
5) Consult with your health care provider before initiating any treatment.
Then you too, can be lying in the green grass…calm, cool and collected!
Lighting the way…
- 1. Roussouw, JE. Et al. (2002) Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized control trial. JAMA; 288: 321-33.
- 2. Carroll, DG. (2006). Nonhormonal Therapies for Hot Flashes in Menopause. Am Fam Physician, Feb 1; 73 (3): 457-464.