“Ask Chris” is a new column where readers can ask questions related to women’s health and wellness issues.

hotflashWhat can I use to help with hot flashes other than hormone replacement therapy?

~Tammy, 50 and Still Hot

This is a common question in my practice. Women who go to the pharmacy or health food store and check out the menopause section will likely be overwhelmed with all the choices. You can be faced with an actual wall of over-the-counter remedies promising to relieve hot flashes, improve your mood, help you sleep, erase your wrinkles, and melt away your unwanted pounds. Do they work?

Lots of research money has been dumped into evaluating the effectiveness of alternative therapies for menopause. The results are not very encouraging. Depending on which studies you believe, there are relatively few choices. The herbal product Black Cohash, has been shown, in some, but not all studies, to relieve hot flashes and night sweats. It is the only herbal product to show much promise in controlled studies. And it is the only herbal that has provided my patients with significant results. I do not track any data, but I would estimate at least 60-70% of women get at least some relief and some get complete relief.

I used Remifemin, the brand of Black Cohash I recommend, for a year with complete and total resolution of moderate to severe hot flashes and night sweats. Down side is that the product can be effective for a time and then stop working. Few women experience any side effects; only a very few have reported stomach upset as the only adverse event.

Remifemin is a brand originally out of Europe, where the supplements are all regulated. Not so in the US, where vitamins and supplements can be manufactured without any dosing standards. What is on the label may not be what is in the pill. Because Remifemin is guaranteed to be “standardized” dosing, it does cost more, but my patients have had better results with this brand versus generic. There are also products that include Black Cohash but also have additional ingredients that are supposed to help with sleep, energy, and/or weight loss. My feeling is that the more ingredients you ingest, the more likely you are to experience side effects.

There are a few non-estrogen prescription medications that may help some women with hot flashes and night sweats. The anti-depressant drug Effexor has benefit for some women. But most woman who are not in need of the anti-depressant or anti-anxiety effects are not excited to take a drug with potential side effects. On the other hand, if a woman is struggling with either depression or anxiety and has menopausal symptoms, then Effexor could prove beneficial. I have had a small number of patients take this drug with good results.

There are some blood pressure medications that have been shown to give modest relief in controlled studies. But I have not seen any benefit in the few patients who have opted for this treatment.

A side note… It has been my experience in treating many, many women over the years that those who enter menopause with significant weight problems or depression have a much more difficult time managing menopausal symptoms. I encourage these woman to be pro-active BEFORE they begin menopause. The importance of exercise and a healthy diet cannot be overstated. And counseling can be an effective tool for those with mental health issues.

More information about menopause can be found on the website of the North American Menopause Society at menopause.org.