The new hot-flashes treatment guidelines come from the North American Menopause Society. An editorial panel led by Nanette F. Santoro, MD, based the recommendations on scientific studies of prescription and nonprescription remedies.
The bottom line: Try lifestyle changes first. These include adding soy, gobble black cohosh tablets, and/or take vitamin E supplements to your diet. But if you're troubled by severe hot flashes, estrogen is still the best treatment.
That puts women -- and their doctors -- between a rock and a hard place. Recent studies raise questions about whether long-term estrogen has more risks than benefits. But there just aren't a lot of good clinical trials of estrogen alternatives.
"Although the trials show estrogen works the "best" for hot-flash relief, head-to-head comparisons of estrogen to the other therapies were often not performed," Santoro notes in a news release. "So it's not really possible to prioritize the nonestrogen treatments in terms of their effectiveness compared with estrogen because the women studied could have differed in ways that made the medications appear more or less effective."
The new treatment guidelines appear in the January/February issue of Menopause.
Lifestyle Changes for Hot Flashes
Early on in the new guidelines, the experts make a startling admission: Nobody knows the exact cause of hot flashes.
All the same, hot flashes are very much what they appear to be. That is, it's all about being too hot. A woman who controls her core body temperature is on the way to controlling her hot flashes. With that in mind -- and with volumes of research behind them -- the experts offer this advise:
- Keep cool. Use a fan, dress in layers, consume cool and cold foods and beverages. Avoid hot foods and drinks that raise one's body temperature.
- Exercise. The more a woman sits around, the worse her hot flashes can be.
- Lose weight. Heavier women tend to have worse hot flashes. It makes sense that losing weight would help -- but there's no strong evidence this is so. Still, dropping a few pounds never hurts if you're overweight.
- Stop smoking. Smokers have more hot flashes than nonsmokers.
- Breathe. Start deep, slow, controlled breathing as soon as you feel a hot flash coming on. It really helps.
And here's another thing that helps: Time. Eventually, the experts say, almost all women get over hot flashes -- even without any treatment at all.