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Complementary and Herbal Therapies for Hot Flushes

Key points

  • Any product used for the treatment of menopausal symptoms should have been shown in clinical studies to be safe and effective. 

  • There have been many trials of complementary and herbal medicines for the relief of menopausal symptoms. 

  • Some lifestyle changes, psychological treatments and hypnosis have shown benefit. 

  • There is currently insufficient evidence to support the use of herbal therapies. 

  • Compounded bioidentical hormonal preparations are not recommended due to major concerns about the safety and efficacy of these products.

 pdfAMS Complementary and Herbal Therapies for Hot Flushes475.65 KB

Many women experience hot flushes and night sweats around the time of menopause. Hormone replacement therapy (HRT) has been proven to be effective in alleviating these symptoms (1). Some women however, choose to explore complementary or herbal therapies for relief of symptoms. There have been a great many trials of complementary and herbal medicines and some of these have suggested benefits from certain therapies and others have shown no benefit. It can be difficult for consumers and for doctors to interpret this mixed information (2). This information sheet provides a brief overview of the current evidence for complementary and herbal therapies.

Complementary and herbal therapies are sometimes referred to as “natural” and may be derived from plants and other sources.  Some people believe that these products are safer than prescription products.  However, scientific studies of these compounds have not supported this belief (2). Extracts from plants and other “natural” products may actually cause harm and can interact with prescribed medicines.  They do not necessarily act like the hormones normally produced by women. Some over the counter treatments, including plant extracts, are not subject to the rigorous testing for content, safety and effectiveness that prescription treatments are subject to.

Any product used for the treatment of menopausal symptoms should have been shown in clinical studies to be effective. This usually requires comparison with a “dummy” therapy (a placebo) or a head to head comparison with a known effective treatment or both. The placebo comparison is particularly important, because there is often a temporary placebo effect of most menopause treatments which commonly lasts around 3 months. Unless the product is tested for more than three months, it is not possible to say that it is truly effective for menopausal symptoms. This short term placebo effect is quite different from the prolonged improvement in menopausal symptoms demonstrated by treatments such as HRT which reduce hot flushes by around 90% and continue to be effective for as long as they are used (3). Prescription drugs cannot be licensed until they have been shown to be safe and effective. This is not the case for “natural” or over the counter remedies for menopausal symptoms. The AMS advocates that all therapies whether prescription or alternative should not be used unless there is good research evidence for effectiveness and safety in the short and long term.

Prescription medicines

A number of prescribed medications have been shown in randomised clinical trials to be more effective than placebo in the treatment of hot flushes and night sweats. A summary of these treatments can be found in the AMS Information sheet ‘NonHormonal Treatments for Menopausal Symptoms’)

Psychological treatments

Cognitive behaviour therapy either in a group or in individual sessions has been shown to be effective in reducing the impact of hot flushes, and in improving sleep and general wellbeing. This approach could potentially be used in conjunction with other therapies for menopausal symptoms.

Lifestyle Changes

Keeping cool by using layered clothing, cooler room temperatures (particularly at night) and  drinking cool liquids may help some women. For those who can identify triggers for their hot flushes (these can include stress, spicy foods or alcohol), avoiding these may help in managing hot flushes, but this has not been tested in clinical trials. Smoking has been reported as a risk factor for hot flushes (4). Stopping smoking may help to alleviate mild symptoms though there are no clinical trials evaluating this. Alcohol can trigger hot flushes and some women find that their flushes will reduce with the avoidance of alcohol.

Weight

Studies in cancer survivors have shown that weight gain may increase the severity of hot flushes (5). However, it is not known whether losing weight will improve hot flushes.

Exercise

Several studies have measured whether exercise improves hot flushes, but the existing evidence does not conclude that exercise helps to reduce hot flushes and night sweats (6).

Exercise has other benefits and may improve quality of life, cognitive functioning, depression, sleep patterns, fatigue, bone density, weight maintenance and cardiovascular disease. (For guidelines on exercise refer AMS Information Sheet ‘Lifestyle advice for healthy ageing’)

Paced Breathing

Slow deep abdominal breathing for 15 minutes twice daily may reduce feelings of anxiety that can occur with hot flushes but does not reduce the hot flushes themselves (7).

Non Herbal Therapies

Acupuncture

Small studies of acupuncture for hot flushes have shown mixed results.  A thorough review of all the studies on acupuncture for hot flushes and night sweats in breast cancer patients did not show any overall benefit  for acupuncture (8).

Hypnosis

There have been limited studies on hypnosis for hot flushes, but a recent carefully conducted trial showed that hypnosis was more effective than an attention control comparison (9). Hypnosis also improved sleep and hot flush interference in this study.

Vitamin E

Vitamin E has not shown benefit in the treatment of menopausal hot flushes after breast cancer, and very limited efficacy in other women (8).

Evening Primrose Oil

Very few studies have addressed whether evening primrose oil improves hot flushes. Existing data shows no benefit (10).

Herbal Therapies

Black Cohosh (Cimicifuga racemosa or Actaea racemosa)

A recent systematic review concluded that there is currently insufficient evidence to support the use of black cohosh for hot flushes. The effect of black cohosh on other important outcomes, such as health-related quality of life, sexuality, bone health, night sweats and cost-effectiveness  is not yet established (11). 

There were originally reports of liver toxicity (12), but these have not been seen in larger studies, and appear to be due to contaminants, though the longest study was only for 6 months (13).

Phytoestrogens including Red Clover (Trifolium pratense )

A wide range of products containing plant or phytoestrogens, including soy products, are available as over the counter remedies for hot flushes.  Studies have varied widely in the dose and nature of compounds tested and the active product of these is thought to be isoflavones. Varied outcomes have been demonstrated with some short term studies suggesting that there may be some benefit in using these products early in menopause but we are still lacking good long term studies. The available evidence suggests that isoflavones do not relieve long term menopausal vasomotor symptoms any better than placebo (14).

There is some evidence that questions the safety of these products in patients with breast cancer and phytoestrogen supplements may interfere with treatments for breast cancer (15).

Wild Yam Cream

There is very limited data on the use of wild yam cream for hot flushes. Existing studies do not show any efficacy in reducing menopausal symptoms (16).

Compounded bioidentical menopausal hormone therapy

Compounded “bioidentical” hormones contain hormonal preparations which are aimed at correcting “hormonal imbalances” which may occur at menopause.  However, there is no evidence to support the effectiveness or safety of these products.  Not only is evidence lacking to support superiority claims of compounded bioidentical hormones over conventional menopausal hormone therapy, but these claims also pose the additional risks of variable purity and potency and lack efficacy and safety data. The Committee on Gynecologic Practice of the American College of Obstetricians and Gynecologists, the Practice Committee of the American Society for Reproductive Medicine and the US Endocrine Society have raised major concerns about the safety and efficacy of these products and recommend that patients be counselled to avoid their use (17). ( Please refer to AMS information sheet ‘Bioidentical Hormones for Menopausal Symptoms’).

Progesterone Cream

Progeststerone cream alone is not effective for the treatment of hot flushes (18).

Progesterone cream also does not provide sufficient endometrial protection if used in conjunction with exogenous oestrogen.

References

  1. MacLennan A, Broadbent JL, Lester S, et al . Oral oestrogen and combined oestrogen/progestogen therapy versus placebo for hot flushes. Cochrane Database Syst Rev 2004;18:CD002978
  2. Nedrow A et al. Complementary and alternative therapies for the management of menopause-related symptoms  Archives of Internal Medicine 2006 166 pp1453-1465
  3. MacLennan A H. Evidence-based review of therapies at the menopause. International Journal of Evidence-Based Healthcare 2009 June (7): 112-123.
  4. Gold EB, Sternfeld B, Kelsey JL, et al. Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age. Am J Epidemiol 2000;152:463.
  5. Caan BJ, Emond JA, Su HI, Patterson RE, Flatt SW, Gold EB, Newman VA, Rock CL, Thomson CA, Pierce JP. Effect of postdiagnosis weight change on hot flash status among early-stage breast cancer survivors. J Clin Oncol. 2012 May 1;30(13):1492-7. doi:10.1200/JCO.2011.36.8597. Epub 2012 Mar 19.
  6. Daley A et al Exercise for vasomotor menopausal symptoms. Cochrane Database Syst Rev. 2011 May 11;(5):CD006108. doi: 10.1002/14651858.CD006108.pub3.
  7. Carpenter JS et  al Paced respiration for vasomotor and other menopausal symptoms: a randomised controlled trial. Journal of General Internal Medicine 2013; 28:193-200
  8. Rada G, Capurro D, Pantoja T, Corbalán J, Moreno G, Letelier LM, Vera C. Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD004923
  9. Elkins GR, Fisher WI, Johnson AK, Carpenter JS, Keith TZ  Clinical hypnosis in the treatment of postmenopausal hot flashes: a randomized controlled trial.   Menopause. 2013 Mar;20(3):291-8. doi: 10.1097/GME.0b013e31826ce3ed
  10. Chenoy R, Hussain S, Tayob Y, O'Brien PM, Moss MY, Morse PF.  Effect of oral gamolenic acid from evening primrose oil on menopausal flushing. BMJ. 1994 Feb 19;308(6927):501-3
  11. Leach MJ, Moore V Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012 Sep 12;9:CD007244. doi: 10.1002/14651858.CD007244.pub2.
  12. Whiting PW, Clouston A, Kerlin P. Black  cohosh and other herbal remedies associated with acute hepatitis.Med J Aust 2002; 177: 440-3
  13. Naser B, Schnitker J, Minkin MJ, de Arriba SG, Nolte KU, Osmers R. Suspected black cohosh hepatotoxicity: no evidence by meta-analysis of randomized controlled clinical trials for isopropanolic black cohosh extract. Menopause. 2011;18(4):366–375. [PubMed]
  14. Eden JA. Phytoestrogens for menopausal symptoms: a review. Maturitas. 2012;72(7):157-9.
  15. Ju Y.H. et al Dietary genistein negates the inhibitory effect of letrozole on the growth of aromatase-expressing estrogen-dependant human breast cancer cells. Carcinogenesis 2008 november;29(11): 2162-2168
  16. Komesaroff PA, Black CV, Cable V, Sudhir K Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women. Climacteric. 2001 Jun;4(2):144-50.
  17. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice; American Society for Reproductive Medicine Practice Committee.Fertil Steril. 2012 Aug;98(2):308-.,
  18. Benster B, Carey A, Wadsworth F, Vashisht A, Domoney C, Studd J. A double-blind placebo-controlled study to evaluate the effect of progestelle progesterone cream on postmenopausal women. Menopause Int. 2009 Jun;15(2):63-9. doi: 10.1258/mi.2009.009014.

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Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.

Content Updated January 2017

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