Nonprescription remedies

While some women report that various over-the-counter remedies help relieve their hot flashes, scientific studies are lacking to support their use. Many experts believe that this hot flash relief can be attributed to the “placebo effect.”

Placebos (inactive medications) have been shown to have a therapeutic effect in many scientific studies of a variety of drugs used to treat a variety of symptoms. This holds true for hot flashes, where a placebo is effective up to 40% of the time in carefully controlled scientific studies. There are also concerns about government regulation of dietary supplements.

Nonprescription remedies used for hot flash relief include the following:

• Isoflavones (weak, plant-derived estrogens), most commonly found in soy foods but also in dietary supplement pills, have been found to reduce mild hot flashes by about 15% to 30% in some studies. However, many other studies show no effect at all. Eating 1 or 2 servings of soy foods daily (25 grams of soy protein) may provide greater benefits than supplements. Low-fat varieties of tofu, tempeh, soybeans, or roasted soy nuts are good choices. An effect on hot flashes, if any, may take weeks. Whether breast cancer survivors should be advised to avoid isoflavones is unknown.
• In some studies, use of a brand of dietary supplement pill containing the herb Black Cohosh decreased hot flashes. One form of the supplement, marketed as Remefemin, is made in Germany where there is good quality control of the manufacturing process. Women taking a 20-mg tablet twice a day for 8 to 12 weeks reported improvement in mild hot flashes, but not all studies show this positive effect. Side effects include gastrointestinal upset, typically with first-time use.

In rare cases, the use of black cohosh appears to cause liver damage. Many other supplement brands of black cohosh besides Remefemin are available, but these do not have much scientific evidence of either efficacy or safety. Some of these supplements may have estrogen-like effects. However, one large study found that using black cohosh at 40 mg/day for 1 year does not cause the lining of the uterus to thicken as estrogen does. Safety beyond 1 year of use has not been studied and is therefore unknown.

• Other nonprescription remedies promoted to relieve hot flashes—including topical progesterone cream and supplements containing the botanicals evening primrose oil, dong quai, ginseng, kava, licorice, or sage—have not been found to be effective in scientific studies. Some of these remedies can cause side effects, occasionally severe.

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