If you want relief from hot flashes and night sweats without taking estrogen, you've got several options!

Suffering from hot flashes and/or night sweats but do not want to take estrogen? Here are some non-estrogen options:

1. Behavioral interventions
Wear layered cotton clothing. Avoid coffee, alcohol, spicy foods, and stress! Sip cool drinks or use ice packs. Relaxation and deep, abdominal breathing (6-8 breaths per minute) have been shown to reduce hot flashes by about 40% when practiced as minimally as twice per day. Eliminate hot baths or showers before bedtime.

2. Vitamin E
Some women experience a reduction in hot flashes when taking Vitamin E. However, a placebo-controlled, randomized study evaluated vitamin E supplements (800 IU/day for four weeks) for 120 breast cancer survivors with hot flashes and found that vitamin E only marginally decreased hot flashes.

3. Soy
The results of the research on soy are inconclusive and contradictory. Some studies have found that soy has a positive effect on hot flashes, whereas others suggest that there isn't any beneficial effect. Christiane Northup, MD, in her book The Wisdom of Menopause, cites research that indicates that women who ate 60 grams of soy protein per day in the form of a powdered drink mix had a 45% reduction in hot flashes after 12 weeks. The following servings contain about 35-50 mg of soy isoflavones: one cup soy milk, 1/2 cup tofu, 1/2 tempeh,1/2 cup green soybeans (edamame), and three handfuls of roasted soy nuts.

4. Natural progesterone cream
A study published in the journal Obstetrics and Gynecology in 1999 found that natural progesterone cream significantly reduced hot flashes compared to the placebo group. In The Wisdom of Menopause, Northrup says that a 2% progesterone skin cream works in about 85% of perimenopausal women. A little as 1/4 tsp once per day can ease hot flashes. Make sure that you read the labels of natural progesterone cream products careful as there is great variability of progesterone content. Some creams contain less than 5 mg progesterone per ounce, whereas others contain more than 400 mg progesterone per ounce. This can be obtained over the counter or by prescription.

5. Herbs
An isoflavone or plant estrogen derived from red clover, Promensil, was found to significantly reduce the number and intensity of hot flashes in a study conducted in 1998-99. However, an article by Adriane Fugh-Berman, MD (The (National Health) Network News, July/August 2002) states that trials of red clover were not effective over placebo for hot flash reduction.

Probably the most common herbal remedy for hot flashes is black cohosh. However, the results of trails have been mixed. Three randomized, controlled trials found that black cohosh was as effective as pharmaceutical estrogen in relieving hot flashes. However, a placebo-controlled, randomized trial, involving 85 women with a breast cancer history, found that black cohosh and placebo similarly decreased the frequency and intensity of hot flashes. However, the authors did note that black cohosh was significantly more effective than placebo in reducing excessive sweating. Side effects are rare but may include gastric discomfort, nausea, and vomiting. It can, however, lower blood pressure. The general recommendation is to use black cohosh for up to six months continuously.

6. Other prescription drugs
Low doses of antidepressants such as Effexor or Paxil have been effective in reducing hot flashes. Clonidine, (Catapres), a drug normally used to treat hypertension, can sometimes help relieve hot flashes. However, it may lower normal blood pressure. A drug that has been used in other countries and is undergoing clinical trials in the U.S. is tibolone (marketed as Liviol). It has estrogen-like effects on hot flashes but does not result in hyperplasia. As a result, this drug may be a promising remedy. Megestrol acetate (Megace) is the only type of progesterone that is FDA approved for women who have had breast cancer and can help diminish the frequency and severity of flashes. An article in Neurology reported on six women taking gabapentin (neurontin) for seizures or migraines who had decreased hot flash frequency and needs to be studied more extensively.

7. Acupuncture and yoga
Acupuncture can be helpful in alleviating hot flashes. Some women have found yoga to be beneficial.

8. Exercise, exercise, exercise!

Source: Joan Starker, PhD, MSW, a clinical social worker since 1970, has spent a major portion of her career helping individuals cope with normal life transitions such as midlife and menopause. A member of the North American Menopause Society, she is on the advisory board of the Oregon Menopause Network.

The opinions expressed herein are Ms. Starker's alone. If you have a question about your health, you should consult your personal physician/alternative healthcare practitioner. This document is meant for informational purposes only. Originally published Aug. 5, 2002.