Alternatives to HRT for treatment of menopausal hot flushes

I speak to many women who do not wish to start HRT (Hormone Replacement Therapy) for various reasons – some have a family history of breast cancer, or risk factors for stroke/heart disease, or simply want something non-pharmacological. Unfortunately there are few good alternatives, although the following are worth discussing with your doctor:

• certain antidepressants may reduce hot flushes by 50% – side effects may limit this form of treatment though. The most popular one at the moment appears to be Efexor.
• Clonidine and Gabapentin, two non-hormonal conventional medications, are also effective – but again, often cause side effects such as dry mouth and dizziness.

It never ceases to amaze me when new over-the-counter products appear on the shelves with very cute names (I won’t name any for fear of libel!) but currently there is little evidence to support the use of these products (and I’ve never met anyone who swore by a particular product either). That isn’t to say that the active ingredients are not effective – it more reflects the lack of research. However, a recent re-appraisal of all the studies on black cohosh (also known as Remifemen) concluded that it is no better than a placebo. Pfft! There goes that! The only supplement with any reasonable evidence so far is soy isoflavone, which may reduce hot flushes by 25%. Recently I’ve come across single studies that suggest Chinese herbal medicine (a formula called “Dang Gui Bu Xue Tang”), pine bark extract and licorice may help but I don’t think it’s wise to draw conclusions from one study – just look at black cohosh.

There’s interest in the mind-body connection with hot flushes, with talk about the link with serotonin and adrenaline, and Prof Myra Hunter in the UK has published studies that suggest psychological strategies, such as cognitive behavioural therapy, can reduce hot flushes. A small study found yoga could be helpful, as well as studies on paced breathing and exercise. Certainly the area of the brain that tells us that we are feeling hot also seems to have a role in emotional control, so this could be another reason why these therapies might help.

I would encourage all women who are flushing to consult their doctors if they are not coping, to discuss their options. Don’t suffer alone! More useful information can be found on the Jean Hailes website and the Australasian Menopause Society website.