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The Menopause Exchange Blog

NON-HORMONAL HELP FOR FLUSHES/SWEATS

Hot flushes and night sweats are the most common menopausal symptoms, but their impact varies from woman to woman. Although they can be distressing and affect quality of life, it’s thought that they only last a short time. However, about 16% of women continue to report these symptoms for longer, with two percent of women complaining of symptoms into their 70s.

This article was included in issue 75 (winter 2017/2018) of The Menopause Exchange newsletter.

Management approaches that don’t involve HRT are available for hot flushes and night sweats, such as self help measures, lifestyle changes, herbal medicines and complementary therapies. Their effectiveness varies from woman to woman, and according to the symptoms.

Self help measures
Making some simple changes to your lifestyle may make it easier for you to cope with menopausal symptoms.

Triggers: Look for (and avoid) any known triggers, such as caffeine, red wine, coffee, hot drinks, spicy foods, eating late at night, caffeine, alcohol and smoking.
Cooling techniques: Wear layers of light clothing and use a lighter duvet or blanket. Use a fan, facial spritz or Chillow pillow.
Cognitive behavioural therapy (CBT): This is a way of talking about how you think and feel about yourself, the world and other people. Changing how you think may change your behaviour and make you feel better. It may help you make sense of problems if you break them down into smaller parts so it is easier to see how they’re connected.
Exercise and yoga
Weight loss
Mindfulness, relaxation and hypnosis

A healthy diet
All women at or around the time of the menopause should aim to eat a healthy diet. Some may find that their diet contains triggers that affect their symptoms. Certain dietary supplements may have an impact too. These are:
Phytoestrogens: These plant substances have a similar effect to oestrogen. They are commonly found in soya products and can also be added to food, such as bread or milk. They are also available in high-dose commercial products, such as red clover. Phytoestrogens are divided into two main groups: isoflavones and lignans. Isoflavones are found in red clover, soybeans, chick peas, and other legumes (beans, peas, kidney beans, haricot beans, broad beans). Lignans are found in oilseeds such as flaxseed, sunflower, sesame, pumpkin, poppy, linseed, cereal bran, oats, barley rye, brown rice, couscous and bulgar wheat, whole cereals, vegetables, legumes and fruit.

Herbs and vitamins
Herbs and vitamins may be perceived as risk free. However, this isn’t always true and there is often little information available. Herbs commonly used for the menopause include agnus castus, black cohosh, ginseng, hops, maca, St John’s Wort, valerian, wild yam, menopausal cream, Dong quai, flaxseed and pollen extract. Combination botanicals (often combinations of herbs) are frequently used in Chinese medicine. However, it’s difficult to assess their effectiveness, and interactions may occur with other medicines, including prescribed ones.

If you’re looking at herbal products, it’s important to:

  • Try one product at a time
  • Calculate the cost
  • Check the practitioner’s qualifications
  • Use herbal remedies with care if there’s a contraindication to oestrogens
  • Check whether there are any interactions with prescribed medicines.

Studies looking at vitamins have mixed results with little evidence for the effectiveness of vitamin E or mixed multivitamins on hot flushes.

Herbal and dietary supplements are not always well regulated so speak to a pharmacist before you buy any products. They may not be suitable for women with hormone-dependent cancers.

Complementary therapies
Complementary therapies may be useful but the evidence in most cases is lacking or mixed. Acupressure and acupuncture aim to balance the body’s energy along meridians. Aromatherapy involves the use of essential oils by either inhalation or through massage. Different oils have different benefits and can be mixed by an aromatherapist for individual symptoms, e.g. lavender may help with insomnia, anxiety, mood swings, headaches and depression. Ayurveda is an Indian health system looking at diet, massage, baths and the use of laxatives. Other complementary therapies include homeopathy, hypnotherapy, osteopathy, reflexology and reiki. Tai Chi may help to prevent falls and conserve bone mass.

Prescribed alternatives
Prescribed alternatives are medicines that were developed for other conditions and then found to have some benefits for menopausal symptoms, normally hot flushes and night sweats. These include:
Clonidine: this was originally developed as a medicine to lower blood pressure. There is conflicting information from clinical trials on its effectiveness on managing hot flushes and night sweats. It has no effect on other menopause symptoms such as sex drive and vaginal dryness or bone density. Side-effects include difficulty in sleeping, dry mouth, dizziness, constipation and sedation.
Some anti-depressants (e.g. venlafaxine) in small doses can help hot flushes and sleep problems. They may interact with some medicines. Side effects can be nausea and reduced sex drive.
Gabapentin is a medicine for pain and can reduce flushes. It can also be helpful if you have aches and pains. However, it can interact with antacids and side-effects include dizziness and drowsiness.

Future hope
In 2017, a small study on a small number of women looked at the role of neurokinin B in relation to hot flushes. It found that the neurokinin 3 receptor antagonist was well tolerated and significantly lowered the number of hot flushes in one week. Further larger studies are needed before this is available

About the author
Debby Holloway is a nurse consultant in gynaecology at Guys and St Thomas’ NHS Foundation Trust.

 Created Winter 2017/2018

Copyright © The Menopause Exchange

References:
Julia K Prague et al, Neurokinin 3 receptor antagonism as a novel treatment for menopausal hot flushes: a phase 2, randomised, double-blind, placebo-controlled trial.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30823-1/fulltext

 

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