Non-hormonal treatments for menopause
By the faculty of Harvard Medical School for The Harvard Medical School Adviser

Q: Since entering menopause, hot flashes sometimes wake me up at night. Because I have a family history of breast cancer, I don't want to take hormones. What other treatments are available, and how well do they work?

A: Hot flashes, which cause sweating, pink or reddened skin, and a slightly raised heart rate, are no big deal for some women. But others feel as though they're "burning up." Some women also feel tense, anxious or unsettled before or during hot flashes, which are common during menopause.

Hot flashes seem to result from a lower tolerance to small increases in the body's core temperature (see illustration). The first tip for avoiding them is to keep cool. Drink cold beverages and avoid hot ones, use fans and air conditioners, and dress in layers. Another trick is to put a cold pack under your pillow, and then turn over your pillow when you awaken with a flash. Some women find that caffeine, alcohol, spicy food and stressful situations trigger hot flashes. Make a note of things that seem to trigger your flashes in a daily diary. Then review it each week to pinpoint your most common triggers, and do your best to avoid them.

Another technique is paced respiration, which some studies show can cut the number of hot flashes a woman has by half. In these studies, women were trained to take slow, deep, full breaths -- expanding and contracting the abdomen gently while inhaling and exhaling. The goal is to breathe at a rate of about six to eight breaths per minute. One of the best ways to learn paced respiration is by taking a yoga class. Then, practice this technique twice a day for 15 minutes. You can also use paced respiration whenever you feel a hot flash coming on.

In addition, certain prescription medications can be effective in relieving hot flashes. Several different antidepressants fall into this group. One study found that venlafaxine (Effexor) reduced the severity and frequency of hot flashes by more than 60 percent. Another study showed that fluoxetine (Prozac) is better than a placebo for relieving hot flashes. Antidepressants also often help relieve the mood swings, depression or anxiety that some women experience during menopause. But since the doses used to treat hot flashes are lower than those usually used to treat depression, their benefits for menopause do not depend on fighting depression.

Gabapentin (Neurontin) is FDA-approved as an antiseizure medication. It is often prescribed to treat pain syndromes and has shown real promise in relieving hot flashes. When it is taken at night, it also works as a sleep aid. But gabapentin's side effects can sometimes include drowsiness, nausea, tremors and a lack of muscular coordination. Lowering the dose usually resolves most of these side effects.

Clonidine (Catapres), a medication used to treat high blood pressure, also helps ease hot flashes. It's effective in about half of women who take it for this purpose. But some women experience side effects -- drowsiness, dry mouth, constipation and insomnia - that are more bothersome than the hot flashes.

Many women are attracted to "all natural" supplements for menopause symptoms, which commonly include herbs such as black cohosh, red clover, kava and others. But products like these, sold as "dietary supplements," are not regulated by the Food and Drug Administration. That means they are not checked for purity, safety or effectiveness. In the past, black cohosh and kava attracted some interest, but this enthusiasm diminished following reports linking these herbs to serious liver damage. Although red clover appears safe, at least two studies failed to find any evidence that it helps quell hot flashes.

Like red clover, soybeans contain estrogen-like compounds that some studies suggest may help ease hot flashes. But the evidence has been mixed. And while eating soy-based foods appears to be safe, some researchers caution that taking concentrated soy extracts (called isoflavones) might increase a woman's risk of breast cancer.

If, after trying the selfhelp techniques, you still find yourself sweaty and sleepless, consult your clinician about trying one of the prescription medications. And, while these uncomfortable episodes may linger for three to five years (on average), most women find that they become more tolerable after the first year of menopause. One of the few nice things about growing older is that you'll leave your hot flashes behind.

Copyright 2006 the President and Fellows of Harvard College. Developed by Harvard Health Publications (www.health.harvard.edu). Distributed by UFS. Submit questions to harvard_ adviser@hms.harvard. edu.