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Natural remedies for hot flushes in menopause (what works, what doesn’t)

Woman at kitchen bench eating fruit

Niki Bezzant, Healthy Food Guide founding editor and author of This Changes Everything: the honest guide to menopause and perimenopause, takes us through the natural ways to help menopause symptoms, and those that are really just a waste of your time and money.

There are hundreds of treatments, supplements, diets, programmes and remedies marketed to women dealing with perimenopause and menopause, all promising to relieve symptoms such as hot flushes, mood issues, sleep problems, brain fog and weight gain.

Based on the research I did for my book This Changes Everything: the honest guide to menopause and perimenopause, the evidence on many natural therapies marketed for menopause – and particularly hot flushes – is, let’s just say, pretty patchy. There are some things that have been studied and have shown measurable effects, so if you’ve found something you feel is working for you, you can afford it and it’s not causing side effects, carry on. But it’s worth knowing a few points about natural remedies, if you’re just starting on this journey.

The experts say they don’t really work

The world’s menopause experts say no natural remedy has been shown to be anywhere near as effective as HRT (Hormone Replacement Therapy). According to the Australasian Menopause Society: ‘No complementary medicine is as effective as oestrogen therapy for menopausal symptoms.’

The International Menopause Society is on the same page: ‘Studies and meta-analyses have not consistently supported the efficacy of complementary or over-the-counter therapies in reducing severity or frequency of hot flushes or night sweats.’

There’s a strong placebo effect

The placebo effect is real: Specifically, there is a 30–50 per cent placebo effect when it comes to menopause therapies for hot flushes. Yes, you read that right. That means that even if we are taking a sugar pill (a typical placebo) or a supplement that does nothing, the act of taking it means there is a pretty good chance we will feel a positive effect from it.

This doesn’t mean our symptoms are all in our heads. The placebo effect has been well studied, and it’s noted as a real and measurable thing.

This is true for trials of drug treatments, too. A 2015 review looking at the placebo effect in studies of pharmacological treatments for hot flushes reported some pretty astonishing findings. One review of nine placebo-controlled trials of oral oestrogen therapy for hot flushes ‘clearly indicated the efficacy of hormone therapy, but also showed that those with placebo treatment had a mean reduction of 58 per cent in hot flash frequency’, the authors wrote.

The same was true for studies of other non-hormonal treatments for hot flushes. The response to placebo in another pooled analysis of 10 clinical trials of non-hormonal flush treatments was between 27 per cent and 52 per cent. Amazing, right? (Though it should be noted that in both of the reviews I’ve mentioned here, the drug being trialled gave significantly better results than the placebo).

In another fascinating twist, a 2020 randomised control trial on women with hot flushes found that even when women knew they were taking a placebo, and had the science of placebo effect explained to them — this is known as an ‘open-label placebo’ trial — they still had a ‘significant’ reduction in hot flushes compared with those receiving no treatment!

Marketers are smart

Research on the placebo effect also shows that how the information is presented makes a big difference to how effective we find a treatment.

“Data show that when information provided to patients was positive rather than negative or neutral, positive treatment effects significantly increased,” noted one review. In other words: we buy into the sizzle.

It’s easy to see how you might sit through, say, a flash YouTube video with a ra-ra presenter and some amazing testimonials for a product; or have an hour with an alternative health practitioner who’s highly empathetic and really listens and relates to your symptoms, and then gently recommends some products to buy that they say will definitely help — and that this might really affect your thinking and have an impact on how well you perceive the treatment to work.

But remember, anyone selling you stuff is a marketer. And it pays to be very wary of over-the-top claims and fancy packaging.

So, what remedies might work?

According to science, there are not many alternative therapies that work for hot flushes — no matter the claims. A big systematic review and meta-analysis published
in the Journal of the American Medical Association (JAMA) in 2016 looked at 62 studies of more than 6000 women and found fairly underwhelming results for most supplements; only a few showed possible benefits (see below).

What might work for hot flushes

Vitamin E may reduce the frequency of hot flushes by one per day in doses of 200 IU/day.

One particular form of black cohosh – isopropanolic Cimicifuga racemosa extract (iCR) – has shown a benefit for flushes. The effect was greatest for women in the early stages of menopause, and in higher doses — up to 120mg per day.

Pine bark extract (pycnogenol) is an emerging supplement that has had a few studies showing possible benefits for menopause symptoms, including hot flushes. One to watch.

Things that don’t work for hot flushes

There’s no good evidence, at the moment, according to the world’s menopause organisations, that any of these products targeted at women to relieve hot flushes has any effect:

  • red clover and other phytoestrogens
  • ashwaganda
  • maca
  • flaxseed
  • omega-3
  • ginseng (note: this can interact with a range of drugs: seek medical advice if you’re considering this)
  • pollen extract (note: this can be bad for people with pollen allergy)
  • evening primrose oil (note: this interacts with some medicines including epilepsy drugs and should not be taken by people with epilepsy)
  • sage (note: this contains a constituent that may cause seizures in high doses).

Stay away from bioidentical hormones

Even though the name sounds like it’s a somehow more ‘natural’ treatment, the term ‘bioidentical hormones’ is basically a made-up term for hormones that are
no different from the hormones you would be prescribed as regular HRT. The difference is: they’re unregulated, untested, uncontrolled and more expensive.

Being ‘prescribed’ bioidentical hormones often means first doing tests — either of the saliva or blood — to ‘personalise’ the treatment to your specific hormonal situation. But the experts say these tests are a waste of time and money, and they are not recommended by any of the world’s menopause authorities. No blood or saliva test can tell you if you’re in perimenopause.

Bioidentical hormones are like supplements, in that there’s no one regulating them. No one is checking they do what they say they do, or that they are safe, or that they even contain what you’re being told they contain. It’s luck of the draw what you get and whether it does any good – and they might be doing harm.

Stick to regulated HRT if you’re looking for hormonal solutions.

*Find more on Niki’s book This Changes Everything, the honest guide to menopause and perimenopause

First published: Apr 2022

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