Which nonhormonal treatments are effective for hot flashes?

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Clinical Inquiries

Which nonhormonal treatments are effective for hot flashes?

J Fam Pract. 2016 May;65(5):E1-E3

By

Gary Kelsberg, MD

Leticia Maragh, MD

Sarah Safranek, MLIS

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References

1. Rada G, Capurro D, Pantoja T, et al. Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst Rev. 2010;(9):CD004923.

2. Nelson HD, Vesco KK, Haney E, et al. Nonhormonal therapies of menopausal hot flashes: systematic review and meta-analysis. JAMA. 2006;295:2057-2071.

3. Lethaby A, Marjoribanks J, Kronenberg F, et al. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database Syst Rev. 2013;(12):CD001395.

4. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev. 2012;(9):CD007244.

5. Saensak S, Vutyavanich T, Somboonporn W, et al. Relaxation for perimenopausal and postmenopausal symptoms. Cochrane Database Syst Rev. 2014;(7):CD008582.

6. Daley A, Stokes-Lampard H, Thomas A, et al. Exercise for vasomotor menopausal symptoms. Cochrane Database Syst Rev. 2014:(11):CD006108.

7. Dodin S, Blanchet C, Marc I, et al. Acupuncture for menopausal hot flashes. Cochrane Database Syst Rev. 2013;(7):CD007410.

EVIDENCE-BASED ANSWER:

Selective serotonin reuptake inhibitors (SSRIs [fluoxetine, sertraline, paroxetine]) and the selective norepinephrine reuptake inhibitor (SNRI) venlafaxine, as well as clonidine and gabapentin, reduce hot flashes by about 25% (approximately one per day) in women with and without a history of breast cancer. No studies compare medications against each other to determine a single best option (strength of recommendation [SOR]: A, systematic reviews and meta-analyses of randomized controlled trials [RCTs]). In comparison, estrogen reduces the frequency of hot flashes by about 75%, or 2.5 to 3 per day.

The phytoestrogens (soy isoflavones, red clover extract, black cohosh), vitamin E, and nonpharmacologic measures (relaxation therapy, exercise, acupuncture, homeopathy, magnet therapy) lack evidence of effectiveness (SOR: A, meta-analyses of RCTs, many of which were low quality).

EVIDENCE SUMMARY

A systematic review of 6 RCTs that evaluated SSRIs and SNRIs (fluoxetine, sertraline, paroxetine, venlafaxine) found them all to be effective for reducing hot flash frequency and symptom scores in women with previous breast cancer¹ (TABLE^1,2).

A 2006 meta-analysis combined the results of 7 RCTs (each evaluating a single SSRI [fluoxetine, paroxetine] or SNRI [venlafaxine]) and found that as a group, they reduced mean hot flash frequency (–1.13 hot flashes/d; 95% confidence interval [CI], –1.70 to –0.57) in women with and without breast cancer.² No trial compared medications head to head, and the populations differed among studies, so that investigators couldn’t determine a single best agent.

Clonidine and gabapentin decrease hot flash frequency

The 2006 meta-analysis also included 10 RCTs (743 patients) that studied clonidine in women with and without a history of breast cancer, and 2 RCTs (479 patients) that evaluated gabapentin in women with breast cancer.² Both drugs reduced mean hot flash frequency (clonidine: –0.95 hot flashes/d, 95% CI, –1.44 to –0.47 at 4 weeks and –1.63 hot flashes/d, 95% CI, –2.76 to –0.05 at 8 weeks; gabapentin: –2.05 hot flashes/d; 95% CI, −2.80 to –1.30).

Evidence-based answers from the Family Physicians Inquiries Network

Which nonhormonal treatments are effective for hot flashes?

References

Clonidine and gabapentin decrease hot flash frequency

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