Sad To Say, Most Remedies For Hot Flashes Fizzle

We know who we are: women of a "certain age" trying to hold back the assault of menopausal symptoms, and we are often desperate. Some of us remain on hormone replacement therapy. But many of us are unable to use hormones for medical reasons or by choice. As a result, droves of us turn to all sorts of treatments, everything from acupuncture to yoga to antidepressants to herbs. And surveys show most women are completely befuddled as to whether any of these treatments actually work.

This is exactly why the North American Menopause Society assembled a panel of experts to look into the scientific evidence, evaluate it and offer recommendations about what works, what might work and what doesn't work at all.

"Many women try one thing after another, and it is months before they stumble upon something that truly works for them," says Janet S. Carpenter, chairwoman of the panel and associate dean of research and scholarship at the Indiana University School of Nursing. Here are the nuts and bolts.

Recommended: The NAMS panel found solid evidence that two behavioral techniques work.

• First, a cognitive behavioral therapy approach that combines relaxation techniques, sleep hygiene and learning how to feel more positive about menopause challenges. This reduced the severity (but not the number) of hot flashes.
• Second, clinical hypnosis. While evidence is limited, the panel found it is likely a promising strategy for managing hot flashes. The panel concludes that both of these mind-body strategies can be recommended to health care providers to advise patients how to handle hot flashes without hormones.

Recommend with caution: Weight loss and stress reduction are always good ideas, but the panel says evidence just isn't there yet to say these lifestyle changes make a difference in hot flashes. When it comes to prescription medication, the panel concludes that selective serotonin reuptake inhibitor antidepressants offer mild to moderate improvement in hot flashes, adding that patients should start out at the lowest dose possible.

Not recommended at this time: The panel reports strong evidence that exercise, yoga and acupuncture, while good for many things, do not work for hot flashes. Over-the-counter and herbal therapies (such as black cohosh, dong quai, evening primrose, flaxseed, maca, omega-3s, pollen extract and vitamins) as well as chiropractic intervention are also unlikely to help.

When it comes to compounded hormones, sometimes called bioidentical therapy, Dr. Wulf Utian, a reproductive endocrinologist, clinical researcher and founder of NAMS, says the label is a marketing ploy without scientific basis.

When considering the variety of herbal products touted to treat hot flashes, Utian says, "virtually" none of them work. He adds the caution that none have been evaluated or monitored for safety and effectiveness by the Food and Drug Administration, which regulates prescription medications.

The hope is these new recommendations will help providers and patients alike make decisions about how to try to regulate their own menopausal symptoms. The position statement was published online Wednesday in the journal Menopause.