Sweating it out
Among the most bothersome symptoms of menopause are hot flashes – sudden feelings of feverish heat – and night sweats. Hormone replacement therapy can help reduce these symptoms, as well as other effects of menopause, including heart disease and osteoporosis.
However, it doesn't suit all women, and concerns about increased risk of breast cancer and personal preferences lead women to try other treatments for hot flashes and night sweats.
In an extensive review of the effectiveness and safety of non-hormonal treatments for vasomotor symptoms – the technical term for hot flashes and night sweats – the North American Menopause Society has released a position statement on the various options promoted for symptom management. The aim of the review is to help women choose therapies known to be effective, while avoiding those that are inappropriate or ineffective.
These treatments have good quality evidence that they're effective. Your doctor can help you determine which is best for you, and recommend practitioners in cognitive behavioural therapy or hypnosis.
Cognitive behavioural therapy – a combination of various measures, including education, paced breathing, relaxation, stress control, and understanding and challenging beliefs about menopause and its symptoms – has been found effective.
Clinical hypnosis – delivered by clinicians trained in hypnosis, this mind-body therapy involves being in a deeply relaxed state, with imagery and suggestion tailored to the individual. Studies have found it successful.
Some antidepressants - especially low-dose paroxetine - and gabapentin (an anti-epileptic drug) have been found helpful, but side effects may outweigh benefits.
The following therapies may help some people:
Weight loss – overweight or obese women who lose weight experience reduced severity and/or number of hot flashes.
Mindfulness-based stress reduction – one study showed some promise but more research is needed.
Soy isoflavones may help some people who have the ability to metabolise them into useful forms – but only about 30% of American women have this ability. Problems with manufacturing processes, resulting in differing compositions and even variations from batch to batch, also limit their broader usefulness.
Watch this space
Studies have found the following treatments have been shown not to work, or haven't been tested adequately, allowing no conclusions to be drawn:
Cooling techniques – choosing clothes designed to keep you cool, keeping the room and bed cool and drinking iced water are commonly recommended, but these methods haven't been studied.
Avoidance of triggers – avoiding spicy foods, and hot foods and liquids is commonly recommended, but hasn't been studied. Alcohol intake had no effect on hot flashes.
Exercise – while offering many health benefits, physical activity hasn't been shown to reduce hot flashes. Most studies test walking or yoga three to five times a week – more vigorous exercise hasn't been studied.
Yoga – studies comparing yoga to no treatment or other forms of exercise found no difference.
Paced respiration – controlling breathing rates was successful in small lab studies, but not in larger studies.
Relaxation – studies on the benefits of relaxation are limited and inconsistent.
Over-the-counter supplements and herbal therapies – there is insufficient evidence in favour of black cohosh, dong quai, evening primrose oil, wild yam, flaxseed, ginseng, omega-3 fatty acids, hops, pine bark, pollen extract, puerpuria and Siberian rhubarb for reducing hot flashes.
Acupuncture – most trials comparing acupuncture to sham acupuncture find no differences in frequency or severity of hot flashes, though trials comparing it with no treatment find it helps.