For most women, menopause means lots of unpredictable changes in their bodies, especially annoying and disruptive hot flashes.
Hormone therapy helps many women, but an increasing number — an estimated 50 percent up to 80 percent — are seeking non-hormonal relief.
But which therapies really, actually work? Which don't have science to back up claims?
After reviewing the medical literature on non-hormonal hot flash treatments, experts at the North American Menopause Society have weighed in with a report published Wednesday.
The downside? The list of treatments that have NOT been proven to work is longer than the list of those that do — and the news may leave many women unhappy.
What's proven to work
- Cognitive behavioral therapy. Cognitive behavioral therapy teaches women “to lower their stress response so the hot flashes are more tolerable,” says Pauline Maki, a coauthor of the group's position statement and president of NAMS. “The more stressed we are, the worse the symptoms are."
- Clinical hypnosis. While hypnosis might sound a little hokey at first, “there are now large randomized trials of hypnosis in which women aren’t even reporting hot flashes,” says Maki, a professor of psychiatry and psychology at the University of Illinois in Chicago.
- Paroxetine salt. The prescription medication has been approved by the Food and Drug Administration to treat hot flashes. “Low-dose paroxetine reduces the frequency of hot flashes and is an option that many with breast cancer are taking,” Maki says. “It’s nowhere as effective as estrogen therapy, but it’s a good option for women who can’t take HRT.”
- Selective serotonin and norepinephrine reuptake inhibitors. Select antidepressants are prescribed for hot flashes.
- Gabapentinoids. Gabapentinoids, which are also prescribed for restless leg syndrome and fibromyalgia, can make you feel drowsy, Maki says. “This is an equation each woman has to solve for herself: is it worse to have the hot flashes or the side effects?"
- Clonidine. The anti-high-blood pressure medication is prescribed for hot flashes and night sweats.
What's not proven to work
Holistic favorites that aren't proven to ease symptoms, according to a review of the science, include:
- Cooling techniques
- Paced respiration
- Trigger avoidance
- Over-the-counter supplements and herbal therapies
The group also listed several treatments that had evidence of efficacy, but were considered less compelling. In other words, they work, but more studies are needed to prove it.
What sort of works
- Weight loss
- Mindfulness-based stress reduction
- Certain derivatives of soy isoflavones. Soy isoflavones called S-equol can be helpful. Most women’s digestive systems can’t process soy in a way that makes it work for menopause symptoms, Maki says, but S-equol takes the digestive system out of the equation.
- An anesthesia technique that involves blocking nerves in the neck A nerve-blocking technique called stellate ganglion block was originally developed to treat pain. It was discovered as a hot flash treatment by accident and has some, but not enough, evidence of efficacy to be added to the list of treatments that definitely work, says Maki.Women who participated in studies of the technique for pain relief reported that not only did it work for its intended use, but it also cut back on hot flashes.
Although it's short, the list of proven techniques is good news, says Pauline Maki, a coauthor of the NAMS position statement, because it shows some non-hormonal treatments are proven to work.
Though they are grateful for the group's findings, some women's health experts aren't about to give up on certain treatments they believe work.
“This article talks about things with really good double blind placebo controlled randomized studies,” says Dr. Mary Peterson, director of the Midlife Health Center at Magee-Women’s Hospital at the University of Pittsburgh Medical Center. “That doesn’t mean the other things don’t work, just that there aren’t studies to back it up.”
If it helps, don't quit
Peterson is surprised trigger avoidance didn’t make the “what works” list.
“I can understand when they say there aren’t any randomized controlled trials, but if my patient says she gets more hot flashes when she drinks red wine, I tell her not to drink red wine anymore,” Peterson says. “That seems like common sense to me.”
Just because something isn’t on the list of proven therapies right now doesn’t mean it won’t eventually be added, says Dr. Neill Epperson, a professor of psychiatry and obstetrics and gynecology and director of the Penn Center for Women’s Behavioral Wellness at the Perelman School of Medicine at the University of Pennsylvania.
While exercise, for example, didn’t make the list, “I know people for whom it works, and I recommend it for everybody,” Epperson says. “Everybody should be doing exercise anyway. So I certainly wouldn’t suggest that women who are exercising [to battle menopause symptoms] stop."
“And if a woman is using acupuncture, whether it’s been shown to be better than placebo or not, if it works for her, she should continue using it.”