As many as 75% of perimenopausal women in North America experience hot flashes, and for a quarter of these women, hot flashes are so disturbing that they seek help.

There is no question that hormone therapy is the most effective treatment for bothersome hot flashes, but in many cases, hormone therapy is not appropriate, and some women simply choose not to try it. In fact, from 50% to 80% of perimenopausal women try nonhormonal therapies for hot flashes, but without any real guidance on what works (and what doesn’t), woman experiment with different products, often delaying their chance at finding effective treatment, wasting capital, or they suffer in silence.

A number of nonhormonal products and techniques are promoted for hot flashes, but they are often untested and unproven. To learn what really works, a NAMS panel of experts looked at the evidence and made recommendations in the Position Statement, “Nonhormonal Management of Menopause-Associated Vasomotor Symptoms.”

The NAMS panel found solid evidence that a few therapies do work, including two behavioral approaches (a combination behavioral approach and clinical hypnosis) and certain nonhormonal prescription medications. Other lifestyle and behavioral approaches, treatments, and a supplement under study (S-equol) look beneficial, but the evidence is not as strong.

Evidence for other lifestyle approaches, herbs, and supplements is insufficient, inconclusive, or just plain negative. The panel found no evidence that exercise, yoga, paced respiration, and acupuncture work on hot flashes, although they may offer other health benefits. They are not recommended as hot flash therapy. Over-the-counter and herbal therapies (such as black cohosh, dong quai, evening primrose, flaxseed, maca, omega-3s, pollen extract, and vitamins), relaxation, calibration of neural oscillations (a brain-training technique), and chiropractic intervention also were not found to work, and risk-free approaches such as stay-cool techniques and avoiding hot flash “triggers” have no studies testing their effectiveness, so these are not recommended therapies either.

The NAMS panel prepared this Position Statement to educate healthcare providers and menopausal women. With this careful, critical look at all the available studies, NAMS has highlighted the need for further research. In the meanwhile, women are better informed on how to handle hot flashes without hormones.

The Position Statement has been published online in the NAMS journal, Menopause.

For some women, miserable hot flashes may resemble Energizer Bunnies. They keep going and going and going well past age 60.

But when these women want to keep using hormones, many Medicare plans, insurance companies, and healthcare providers say no because supposed safety concerns put hormones on a standard list of medications that older people shouldn’t have, called the “Beers list.”

NAMS thinks there shouldn’t be a hard and fast rule against hormones after age 65. Yes, there may be safety concerns, and the Society does recommend that a woman use the lowest dose of hormones for the time appropriate to meet her needs. But NAMS has also stated that, under some circumstances, hormone therapy can be OK for women over age 65. They can be appropriate when the benefits for hot flashes outweigh the risks or when a woman has a high risk of bone fractures and can’t take other bone drugs or can’t withstand their side effects.

In fact, that Beers list wasn’t meant to be a hard and fast rule, and it has changed. In 2012, it added a new category of medications that should be used “with caution.” And that’s just how to use them—knowing what the risks are and having your doctor monitor you closely for any problems. NAMS calls it “judicious use.”

You can read the official statement from NAMS about continuing hormones after age 65 here.

The North American Menopause Society maintains a search feature on this Web site for those women in the United States or Canada who are searching for physicians and other healthcare providers interested in helping them manage their health through menopause and beyond. Those who have passed a competency examination leading to the prestigious credential of NAMS Certified Menopause Practitioner are noted in the displayed results.

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