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    Treating Hot Flashes Without Hormones

    Review Shows Estrogen May Work Better Than Nonhormonal Therapies

    Review's Results continued...

    "These therapies may be most useful for highly symptomatic women who cannot take estrogen but are not optimal choices for most women," write Nelson and colleagues.

    The researchers found no sign that red clover isoflavone extracts reduced hot flashes. The results on soy isoflavone extract studies were mixed.

    As Nelson's team noted, some studies were higher in quality than others. Also, some trials included women who had had breast cancer and were taking tamoxifen; those women may not represent other menopausal women. Hot flashes are a common side effect of tamoxifen use. Those limits may make it hard to draw definite conclusions.

    Second Opinion

    The research review was "technically rigorous" but showed mixed results, and several of the drugs studied can have side effects, states a journal editorial.

    The editorialists were Jeffrey Tice, MD, and Deborah Grady, MD, MPH, of the medicine department at the University of California, San Francisco. Grady also works at the San Francisco Veterans Affairs Medical Center.

    "Antidepressants, clonidine, and gabapentin have been marketed for a long time but large, long-term trials (similar to the Women's Health Initiative trials of hormone therapy) are lacking," write Tice and Grady.

    "Safety is a particular concern for isoflavone extracts because they contain estrogenic compounds and thus may be subject to some of the same long-term adverse effects as hormone therapy," the editorialists add.

    Editorialists' Advice

    More research is needed to understand how hot flashes work, write Tice and Grady. Meanwhile, they offer these tips for managing hot flashes:

    • Dress in layers.
    • Keep the home and bedroom cool.
    • Know that most symptoms resolve over several months to several years.
    • Understand the risks and benefits of hormonal and nonhormonal treatments.
    • With all medicines or dietary supplements used as treatments, take the lowest effective dose and stop as soon as symptoms improve or end.
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