Abstract
Nonhormonal medications and complementary and alternative therapies are used by many
women seeking relief from bothersome hot flashes. However, health care professionals
may be less familiar with these treatment modalities. Although estrogen remains the
most effective medication to reduce hot flashes, its potential harmful effects have
led investigators to examine other treatments for hot flashes, and many women seek
alternative forms of relief. Most of these trials are limited by a significant placebo
effect, which frequently equals the effectiveness of the medication being evaluated.
Despite this limitation, selective serotonin reuptake inhibitors (SSRIs), serotonin
norepinephrine reuptake inhibitors (SNRIs), and gabapentin have robust evidence for
hot flash reduction. Each of these may be chosen for additional treatment effects
that may benefit some women. Complementary and alternative medication trials are fraught
with additional limitations, namely, a large placebo effect, greater homogeneity of
participants, lack of validated tools, and lack of robust reporting of adverse effects.
The data appear most robust for isoflavone supplementation, with overall hot flash
reduction similar to the SSRIs, SNRIs, and gabapentin. Mindfulness-based stress reduction
therapy also has evidence of effectiveness and may be an ideal choice for some. Primrose
oil, Chinese herbal medicine, acupuncture, and yoga have mixed results. The concerns
related to hepatotoxicity preclude the use of black cohosh. Exercise, relaxation,
and paced respiration have no proven benefit thus far in reducing hot flashes. Our
goal with this commentary is to arm clinicians with information about the medications
and complementary therapies available to provide symptom relief to women. Providing
information about the possible benefits and harms of these therapies despite the limitations
of the current evidence is helpful to patients and can help guide them to seek the
treatment option most beneficial and appealing to them.
Key words
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Article info
Publication history
Published online: September 12, 2018
Accepted:
August 18,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
