75 percent of menopausal women in the United States will experience hot flashes. The flashes most often begin in the perimenopausal period when estrogen deficiency occurs together with irregular (anovulatory) cycles.  Obesity, smoking, and less physical activity do increase your risk of hot flashes and the exact mechanism for hot flashes is still unknown. I am regularly asked by my patients suffering from hot flashes for non- hormonal options.  Here are some options for cooling the flashes for those who can't or don't want to take hormones.

1)  Lowering room temperature: I know it sounds easy, but studies have shown that a simple lifestyle measure, lowering room temperature, reduced the number of hot flashes in symptomatic women.

2) Behavioral interventions: A relaxation-based method, known as paced respiration, has been shown in small studies to significantly reduce hot flashes but this therapy is not widely available. Strangely, studies have NOT found a beneficial effect of exercise on hot flashes, possibly because exercise raises core body temperature, thereby triggering hot flashes.

3) SSRIs (the Anti-depressants): The selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SNRIs) have been shown in a number of trials to relieve the symptoms of hot flashes. Effexor and Paxil are the two with the best results in studies but pros and cons of SSRI and SNRI therapy need to be discussed with your doc.

4) Gabapentin (Neurontin): Gabapentin appears to be effective in reducing the frequency of hot flashes. In several trials 900 mg a day (and in some studies only 300 mg at night was needed) was more effective than placebo for reducing hot flashes.

5) Clonidine: Clonodine, a medication also used for high blood pressure, effectively relieved hot flashes in some but not all clinical trials. In a woman with hypertension, clonidine might be considered as initial therapy. A patch which is left in place for one week has been shown to reduce the frequency of hot flashes in 80 percent of womenlacebo

6) Black Cohosh: Among the alternative therapies available for management of hot flashes, black cohosh is one of the most widely used. Some small, short-term, trials suggested benefits from black cohosh but most have not.

7) Phytoestrogens: Phytoestrogens are nonsteroidal compounds that occur naturally in many plants, fruits, and vegetables and also appear to be no more effective than placebo for hot flashes. Phytoestrogens are found in soybeans, chickpeas and lentils.

8) Other herbal options: Though I think if cost permits they are worth a try, a systematic review of ten clinical trials found there was no reduction in hot flashes with ginseng, dong quai, evening primrose oil, Acupuncture, and wild yam

9) Vitamin E : Vitamin E was associated with a decrease in hot flushes in one trial

10) Rhubarb extract (Phytoestrol-N): A very recent study did show some good results for rhubarb extract. Women who consumed one tablet containing 4 mg of the extract Rheum rhaponticum (or Phytoestrol-N) ) everyday for 12 weeks had significant reduction in the number and severity of hot flashes

Hope this helps!

Dr O.

.