The first alternative to hormone therapy for treating hot flashes should be a lifestyle approach, such as instituting an exercise regimen or practicing controlled breathing techniques, according to a statement released in January by the North American Menopause Society.
The group's purpose in releasing the statement is to get clinicians to consider the use of alternatives to estrogen with or without progesterone for treating those patients who may have misgivings about hormone therapy and are willing to tolerate therapy that may be less powerful, said Dr. Nanette F. Santoro, chair of the committee that drafted the statement.
"There has been estrogen, and then everything else, and clinicians have rarely reached for those other things," said Dr. Santoro, director of the division of reproductive endocrinology at the Montefiore Medical Center in the Bronx, N.Y. "But we seem to have some reasonable alternatives, particularly with the SSRIs."
The statement reviews the evidence for several commonly used alternative treatments, as well as the use of hormone therapy. Many in the menopause-treatment community praised the document for what they called its meticulous completeness.
Observational studies show that lowering air temperature can reduce hot flashes. Some other methods that women can use to keep cool include using a fan, dressing in layers so clothes can be removed easily, and consuming cold foods and drinks while avoiding hot food and drinks.
While exercise can cause women to perspire and can elevate core body temperature, studies have shown that fit women experience as many as 50% fewer hot flashes than age-matched sedentary women.
A high body mass index is associated with more frequent and severe hot flashes, which provides some rationale for using weight loss as an approach to treatment, according to the statement.
In addition, smokers experience more hot flashes.
Paced breathing appears to be the most effective of the relaxation-type techniques studied. In three randomized, prospective trials, women who practiced paced breathing had 50% fewer hot flashes than controls.
Clinical trials of the common nonprescription remedies that some women try have mostly shown no efficacy, or various trials have had conflicting results, according to the statement.
However, since alternatives such as vitamin E, isoflavones, and black cohosh appear to have little potential for adverse effects, they can be an option.
Isoflavones, or phytoestrogens, come from two common sources--soy and red clover, the statement notes. One Japanese study reported that the 30%-50% of women who convert the daidzein contained in soy into equol, a nonsteroidal estrogen, are more likely to have benefit than women who do not. …