Need Hot Flash Relief That’s Not HRT? Natural Options to Try


Q. I?ve stopped hormone replacement therapy (HRT) because of recent concerns, but now am again plagued by hot flashes. What else can I try?

A. Though no remedy is as effective as hormones, a few herbs have research to back them, says herbalist David Winston, a founding member of the American Herbalist Guild. The nonprofit North American Menopause Society gives both black cohosh and soy foods the green light. Other touted remedies like vitamin E, ginseng, dong quai, red clover, evening primrose oil and wild yam are not well studied.

HRT Whammy. Though HRT provides effective relief from hot flashes, new data from the Women’s Health Initiative found that long-term use of Prempro (estrogen + progestin) resulted in slight but definite increases in breast cancer, heart attacks, blood clots and strokes compared to placebo. Another study found that long-term use of estrogen alone increased ovarian cancer risk. Both studies appeared in the July 17 Journal of the American Medical Association.

Most experts believe it’s still safe to use HRT for three to five years to ease the discomforts of menopause and protect against osteoporosis and colon cancer. But you may be able to manage hot flashes with herbal remedies plus diet and lifestyle changes. After discussing with your doctor, try the following, culled from the advice of Winston and the North American Menopause Society.

Lifestyle Modifications. Wear loose clothing that breathes, sleep in a ventilated room and limit stressful situations. Avoid steaming hot beverages and soups, as well as spicy foods and alcohol, all of which can trigger hot flashes.

Black Cohosh (Cimicifuga racemosa). Capsules, tinctures and teas of this herb may tame hot flashes via a nonestrogenic mechanism, though it may take several weeks to notice improvement. Remifemin is the standardized brand used in many clinical trials. It supplies a daily dose of 40 milligrams.

Chasteberry (Vitex agnus-castus). Often called vitex, this herb is thought to balance progesterone and estrogen levels. A typical dose is 30 to 40 drops of tincture twice daily, but follow label guidelines. A combination of black cohosh and vitex may modulate hot flashes better than either herb alone.

Soy Foods. Clinical studies have shown mixed results, but experts suggest trying one to two soy foods daily. Winston favors fermented soy, such as miso and tempeh, the form most enjoyed by Asian women who rarely complain of hot flashes. But soy milk, soy nuts and tofu also provide isoflavones, which may be what’s responsible for soy’s benefits. Avoid soy protein powders and soy supplements (including Promensil, which contains isoflavones from the herb red clover); they may contain excessive levels of isoflavones that could do more harm than good.

EN‘s Bottom Line. Taking HRT for hot flashes for a few years may still be safe. But natural remedies are worth a try, with lifestyle modifications, black cohosh and soy topping the list.

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