Alternative Treatments for Hot Flashes (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
What alternative treatments for menopause have been scientifically studied?
The alternative treatments for menopause that have been studied in well-designed trials include phytoestrogens (plant estrogens, isoflavones), black cohosh, and vitamin E.
Isoflavones are chemical compounds found in soy and other plants (such as chick peas and lentils) that are phytoestrogens, or plant-derived estrogens. Red clover is another source of isoflavones that has been used by some women in an attempt to relieve hot flashes. isoflavones have a chemical structure that is similar to the estrogens naturally produced by the body, but their effectiveness as an estrogen has been estimated to be much lower than true estrogens.
Some studies have shown that these compounds may help relieve hot flashes and other symptoms of menopause. In particular, women who have had breast cancer and do not want to take hormone therapy (HT) with estrogen sometimes use soy products for relief of menopausal symptoms. However, some phytoestrogens can actually have anti-estrogenic properties in certain situations, and the overall risks of these preparations have not yet been determined. There is some concern because of the fact that these products are selective estrogen receptor modulators (SERMs), that phytoestrogens may stimulate breast cancer growth or limit the antitumor effects of tamoxifen (Nolvadex). Data are conflicting in this regard, and it is important for women to understand that the long-term risks and potential effects of phytoestrogens have not been fully characterized. For example, researchers have shown that long-term use of phytoestrogens in postmenopausal women led to an increase in endometrial hyperplasia (overgrowth of the tissues lining the uterus) which can be a precursor to cancer.
There is a perception among many women that plant estrogens are "natural" remedies and therefore safer than HT, but their safety has never been proven scientifically. Further research is needed to fully characterize the safety and potential risks of phytoestrogens.
Black cohosh is an herbal preparation that has been popular in Europe for the relief of hot flashes. This herb is becoming more and more popular in the U.S., and the North American Menopause Society does support the short-term use of black cohosh for treating menopausal symptoms, for a period of up to six months, because of its relatively low incidence of side effects when used over the short term. Some studies have shown that black cohosh can reduce hot flashes, but most of the studies have not been considered to be rigorous enough in their design to firmly prove any benefit. The Herbal Alternatives for Menopause Trial (HALT) study, a one-year study described below, failed to establish any benefit of black cohosh in the treatment of hot flashes. There have also not been scientific studies done to establish the long-term benefits and safety of this product. Research is ongoing to further determine the effectiveness and safety of black cohosh. There is some concern about the potential estrogenic effect of black cohosh on the breast, and it is not recommended as a safe therapy for women with breast cancer or who are at high risk for breast cancer.
The Herbal Alternatives for Menopause Trial (HALT) was a one-year study carried out with 351 peri- or postmenopausal women experiencing hot flashes and other symptoms of menopause. The women were randomly assigned to receive one of five treatments: black cohosh alone, a multibotanical regimen that included black cohosh (and other herbal ingredients such as ginseng and dong quai), the multibotanical regimen plus dietary soy counseling, conjugated estrogen 0.625 mg (with or without medroxyprogesterone acetate), or placebo. After one year of therapy, conjugated estrogen reduced hot flashes more than placebo, but there was no significant reduction in the frequency or severity of hot flashes with black cohosh or with any of the herbal interventions when compared to placebo at any of the follow-up times.
Some women report that vitamin E supplements can provide relief from mild hot flashes, but scientific studies are lacking to prove the effectiveness of vitamin E in relieving hot flashes. Taking a dosage greater than 400 international units (IU) of Vitamin E may not be safe, since some studies have suggested that greater dosages may be associated with cardiovascular disease risk.
Other alternative therapies
There are many supplements and substances that have been advertised as "natural" treatments for symptoms of menopause, including ginseng, licorice, evening primrose oil, dong quai, chasteberry, and wild yam. Scientific studies to prove the safety and effectiveness of these products have not been performed, although the HALT study (see black cohosh, above) showed that ginseng and dong quai were no more effective than placebo in the treatment of hot flashes.
The North American menopause Society recommends that women try behavioral modifications such as attempting to keep the core body temperature cooler to help relieve hot flashes. Other behavioral changes such as regular exercise, are also encouraged. However, several studies have failed to prove a beneficial effect of exercise on hot flashes, possibly because exercise raises core body temperature and may in fact trigger hot flashes. Still, regular exercise has important benefits in the prevention of obesity, cardiovascular disease, diabetes, and other conditions and in maintaining physical and emotional well-being.
Relaxation therapy and stress management interventions do not appear to be effective in the management of hot flashes, according to scientific studies. However, these interventions may be beneficial for women in maintaining overall health and well-being during the menopausal transition.
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