Coping with Symptoms without Medication

Some women find daytime hot flashes more problematic than night sweats. They can be a source of embarrassment when they occur in the middle of a busy workday or during an important meeting or presentation. Night sweats are more bothersome for other women, as they can interfere with sleep and result in fatigue and irritability the next day. Fortunately, there are many different ways to cope with hot flashes and night sweats. These symptoms often respond well to some lifestyle changes, such as:

• Dressing in layers, so that garments can be removed to assist with cooling when a hot flash occurs.
• Avoiding triggers for hot flashes, such as spicy foods, caffeine, warm drinks, alcohol, and smoking.
• Achieving and maintaining a healthy body weight. Studies have shown that hot flashes are more severe in women who are significantly overweight.
• Using paced respiration (slow, deep, abdominal breathing) when a hot flash begins.
• Using meditation or yoga during the daytime.
• Getting regular exercise earlier in the day to promote more restful sleep. Exercise that is done within a few hours of bedtime may be too stimulating, so it is best to exercise earlier in the day.
• Winding down with a leisurely lukewarm bath any time of day that you can fit this in.

When lifestyle interventions do not provide relief, some women have found that their symptoms improve by adding certain foods or supplements to their diets.  For most of the items listed below, some studies show that their use may improve symptoms while other studies show that there is no benefit from them at all. Each of these foods or supplements may be worth trying for a few weeks to see if they provide any benefits for you.

• Soy foods: Some women find that adding soy foods to their diets will help with hot flashes and night sweats. Soy foods contain phytoestrogens (plant estrogens), which are plant-derived compounds that are chemically similar to estradiol (the predominating estrogen in premenopausal women) and have weak estrogen-like effects. The specific types of phytoestrogen found in soy are called isoflavones, and soy foods vary in the amount of isoflavone that they contain. Raw soybeans have the highest isoflavone content, followed by soy flour and soy protein isolate. Tofu, tempeh, and soy milk have lower concentrations of isoflavones, but may still be beneficial if consumed in a large enough quantity. Concentrated soy isoflavone extracts are also available as a dietary supplement.
• Red clover isoflavone extracts: Red clover is another source of isoflavones, and supplements are available that contain concentrated red clover isoflavones. Red clover, unlike soy, has not ever been a part of the human diet, and experience with red clover isoflavones is therefore more limited and the evidence of its effectiveness is very limited as well.
• Black cohosh (Cimicifuga racemosa): This is a Native American herb that has had many years of use in treating hot flashes and night sweats. The Remifemin® brand of black cohosh was used in most of the studies on the effectiveness of this herb, and it is widely available. It can take 8-12 weeks for black cohosh to have its full effect. There have been a number of reports that suggest that there may be a link between the use of black cohosh and liver failure, so this herb should definitely be used with caution.
• Evening primrose (Oenothera biennis) oil: This supplement has been used in the treatment of hot flashes and night sweats, but the only randomized controlled trial of its use showed that it did no more to relieve these symptoms than placebo did. Possible side effects include nausea, diarrhea, and inflammation, so it should be used with caution.
• Dong quai (Angelica sinensis): This herb has been part of traditional Chinese medicine for at least 1200 years. In Chinese medicine, it is used as one component of an individualized mixture of herbs for a particular patient. When used in this way, it may be helpful for alleviation of bleeding irregularities and perhaps hot flashes. However, when used alone, it can actually cause bleeding to be heavier. It should not be used in women with bleeding disorders or fibroids for this reason, and should never be used in women who are using anticoagulants (blood thinners).
• Chasteberry (Vitex agnus-castus): This herb is also known as vitex. It has been shown in randomized controlled clinical trials to be helpful in treating PMS, normalizing the length of the luteal phase, and increasing progesterone levels in the second half of the menstrual cycle. However, there is a downside, and it’s the side effect responsible for the name “chasteberry”: it can reduce libido (sex drive) in some women, and should therefore be used with caution in women who already have problems in this area.

Other herbs that have been used in treating menopausal symptoms, either by themselves or as part of an herbal mixture, include licorice (Glycyrrhiza glabra) and sage (Salvia officinalis). Caution is advised when using either of these due to possible side effects.