Treatments for menopausal hot flashes put to the test

Women who take vaginally administered estrogen supplements could escape some of the sexual problems that accompany menopause, according to a new study. (wavebreakmedia / shutterstock.com)

A vast array of products and techniques exist for easing hot flashes and a panel of experts from the North American Menopause Society (NAMS) analyzed and tested them.

While the majority of menopausal women experience hot flashes, many bypass hormone therapy due to medical restrictions or choice and between 50 and 80 percent try non-hormonal therapies at some point.

Evidence suggests several therapies work, including two behavioral approaches and some non-hormonal prescription medications.

Cognitive behavioral therapy that combines relaxation techniques, sleep hygiene and a positive approach to the challenges associated with menopause significantly reduced the problems that arise from hot flashes -- but not their number -- in the panel's trials.

Clinical hypnosis demonstrated itself as being significantly more beneficial than a "structured attention" therapy approach, according to the panel.

Other approaches that might work but for which evidence is not as strong include weight loss, stress reduction, blocking a nerve called the stellate ganglion and consuming a soy-derivative called S-equol.

The panel recommends the aforementioned treatments with caution and cognitive behavioral therapy and clinical hypnosis first and foremost.

As for non-hormonal medicine, selective serotonin reuptake inhibitors (SSRIs) -- also known as anti-depressants -- offer mild to moderate improvements and one that's called paroxetine exists specifically for hot flashes.

Other helpful medications include serotonin-norepinephrine reuptake inhibitors (SNRIs), including venlafaxine.

Also on that list are gabapentinoids such as gabapentin and pregabalin -- used to treat a variety of conditions including epilepsy, anxiety and restless legs syndrome -- in addition to clonidine that's normally used to treat high blood pressure.

The panel notes that a doctor could prescribe these medications starting at the lowest dose and taking into account the potential risks for each individual patient.

As far as non-pharmaceutical treatments go, strong evidence suggests that yoga, breathing exercises and acupuncture are not effective solutions for hot flashes, yet keep in mind they offer other health benefits that could increase quality of life.

Herbal and over-the-counter treatments including evening primrose, flaxseed, omega-3s, maca, pollen extract and vitamins are unlikely to help, according to the panel.

Stay-cool techniques aimed at avoiding hot flash triggers are not recommended, despite the fact that they are risk free, for no research exists attesting to their effectiveness.