Hot Flashes and Night Sweats: The Truly Non-Hormonal Treatment Options
Written by Dr. Alyssa Dweck, MS, MD, FACOG, Chief Medical Officer
“Is it Hot in Here or Is It Just Me?”If you are one of the more than 70% of women in menopause flashing day and night, consider yourself in good company. Of the 64 million menopausal women in the U.S., more than 70% suffer from vasomotor symptoms (which, by definition, are menopausal hot flashes and night sweats). These pesky and disruptive symptoms are the result of when the thermoregulatory zone in the brain (the body’s central thermostat) goes rogue. While they can vary in frequency, intensity and duration, hot flashes and night sweats are no laughing matter. They can disturb your day-to-day quality of life, with the most recent data from SWAN (Study of Women’s Health Across the Nation) suggesting vasomotor symptoms can last for an average duration of 7.4 years but can continue for a whopping 15 years of “heat,” if you’re one of the lucky few.
So Why Me?Blame your mother! Your menopause experience is in part genetic. In addition, African American or Latina women, smokers and those who are overweight, tend to have a more notable experience… and not in a good way.
What’s a “Really Hot” Woman to Do?For one, seriously consider making some important lifestyle changes. The Mediterranean diet, which is rich in lean protein, fresh fruits, and vegetables, rich in olive oil instead of butter, and is low in simple carbs and salt, is preferred. Eliminate common “flash” triggers: yes ladies, this means minimizing some of our favorites like caffeine, alcohol, larger meals and stress. Regular exercise is a must. Some women tend to find mindfulness beneficial; and yes, there’s an app for that! (Consider Calm or Headspace for 10 minutes of peace to start the day). Acupuncture is another option.
What about Phytoestrogens?
These plant-based substances are chemically similar to estrogen, the hormone that plummets during menopause. Soy based foods, including tofu and tempeh, contain phytoestrogens. Various other phytoestrogens, including black cohosh, red clover and soy-based isoflavones, are all available in supplement form, over the counter. Most studies suggest that these are no more helpful than placebo, which in itself shows a 30% reduction in hot flashes. Since these plant-based supplements are chemically similar to estrogen, women with a history of breast cancer, current or past, should consider alternatives and speak with their health care providers prior to making a decision. Caution is also advised when mixing phytoestrogens and other medications metabolized through the liver.
Is there a Really, Truly Non-Hormonal option?In fact, Relizen® is just that! This over the counter nutritional supplement is the real deal when considering a “really, truly NON-hormonal” option for hot flashes, night sweats and improvement in day-to-day quality of life, including improved sleep! Made from a proprietary pollen blend extracted from four specific Swedish plants, and likely working through serotonin-like pathways in the brain, Relizen® has been shown in several clinical studies to lessen the frequency and intensity of menopausal hot flashes and night sweats by more than 70%.1 In fact, results were so notable that a significant number of women in additional survey studies (upwards of 80%) opted to remain on Relizen® voluntarily once the studies were completed.2 Of equal importance, side effects different from placebo were not reported and use in breast cancer patients is not controversial since Relizen® is not a phytoestrogen and does not act like estrogen in the body.
Why are Hormones So Controversial?While traditional hormone replacement therapy (HRT) using estrogen and progesterone, bioidentical or synthetic, is surely effective for addressing menopausal vasomotor symptoms, they come with some baggage. There may be an elevated risk of breast cancer, uterine cancer and cardiovascular disease with use. Similar concerns exist for compounded bio-identical varieties. Always check with your doctor if you have concerns.
But I’m Not Depressed!Specific antidepressants in the SSRI /SNRI classes are often recommended for dealing with hot flashes and night sweats. They are particularly helpful in those women who are also dealing with depression but are indicated for vasomotor symptoms as well. While effective and well studied, sexual side effects, including low libido and orgasm difficulties are unfortunately also common side effects. No thank you! Use with tamoxifen is relatively contraindicated as well.
I Just Need Some Sleep!Gabapentin is an epilepsy and nerve pain medication we have borrowed from our neurology colleagues to treat vasomotor symptoms. It is effective for easing menopausal hot flashes and night sweats, but at the same time, causes excessive drowsiness – for this reason, Gabapentin is a non-hormonal option for those with night sweats and sleep disturbances. This is a prescription medication taken nightly. Traditional sleeping pills do not diminish hot flashes but may help with sleeping through them. Grogginess, headache and vivid intense dreams are all potential side effects.
Hormones Are Not for Everyone
It seems that the “less is more” approach is all the rage these days when addressing the vasomotor symptoms accompanying menopause. Whether you cannot or just will not take hormone therapy, consider these non-hormonal options. For those of you who opt for the real deal, truly non-hormonal path, safe and effective choices are finally here!
Based on data from: Winther K, et al. Climacteric. 2005;8:162-170., Elia D, Mares P. Genesis. 2008:135:12-15., Hellstrom AC, Muntzing J. Menopause. 2012;19(7):825-829., and Munoz E. VivaCell Biotechnology GmbH. Internal Report. July 2012.
Survey data. Goldstein SR, Veledar E, Perez Ojalvo S, et al. Menopause. 2017;24:14:1455.