“While women are commonly told to avoid VMS triggers and dress in layers, there is no evidence that such advice is of value with respect to the severity or frequency of VMS. Activities such as yoga, mindfulness, relaxation and exercise have health benefits but have not been shown to be meaningful treatments for VMS. Similarly, nutritional supplements and botanicals have not been found to be more effective than placebo for moderately to severely bothersome VMS in robust clinical trials”.²

“The following non-hormonal therapies have evidence to support their use to alleviate VMS.

The selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are effective in some, but not all, women with VMS…

Fezolinetant is a neurokinin 3B receptor antagonist that acts centrally in the brain to reduce VMS. It may improve sleep quality by reducing nocturnal VMS. Fezolinetant has been approved for the treatment of VMS at a dose of 45 mg/day in some countries.

Low-dose oxybutynin has been found to be effective for treatment of VMS either as a standard low-dose or extended-release formulation.

Other potential, but probably less effective, options include clonidine and gabapentin/pregabalin. Clonidine may be prescribed for VMS for women who cannot take estrogen at a dose of 100–150 μg/day, although the effect is modest and it is not consistently recommended…

Hypnosis may diminish VMS frequency and severity in postmenopausal women and can be considered a treatment option for women who are unable to take MHT.

Cognitive behavior therapy employs psychotherapeutic behavior modification to help women deal with VMS. Cognitive behavior therapy has been shown to significantly reduce VMS.

Stellate ganglion blockade at the anterolateral aspect of the C6 vertebra on the right side under fluoroscopy can alleviate severe VMS for up to 12 weeks. This procedure requires a highly skilled practitioner and availability is scant”.³

“Nonhormone Treatment Options

Recommended
The treatments with research showing they are effective for treating VMS include:

• Clinical Hypnosis…
• Cognitive-Behavioral Therapy…
• Fezolinetant
• Gabapentin
• Oxybutynin
• SSRIs/SNRIs
• Stellate Ganglion Block
• Weight Loss

Not Recommended

Treatments not recommended for VMS either because there is evidence showing that they do not reduce VMS or because there is not enough evidence showing that they are effective in reducing VMS include acupuncture, paced respirations, supplements/herbal remedies, cooling techniques, avoidance of triggers, dietary modification, exercise, yoga, mindfulness-based intervention, relaxation, suvorexant, cannabinoids, calibration of neural oscillations, chiropractic interventions, clonidine, and pregabalin”.⁴

“Elinzanetant, which is going to be marketed as Lynkuet, is a new FDA-approved non-hormone prescription drug. It’s a neurokinin-targeted therapy and it works on 2 neurokinin receptors: neurokinin 1 and neurokinin 3. And we hope it’ll be a choice for many menopausal women who are having moderate to severe hot flushes, including those who either want a non-hormonal treatment or want a new treatment option. And it’s important when we talk about this to remember that hormone therapy remains the most effective treatment for hot flashes, but 9% of women in the US have contraindications to hormone therapy, and not all women with menopausal symptoms choose or can take hormone therapy. So the new therapies, both fezolinetant (Veozah) and elinzanetant, are effective, safe, tested, and FDA-approved therapies, but there are some important differences between the 2 drugs”.⁵

“…CBT, by changing behaviours and thought patterns surrounding hot flushes, can dramatically reduce their frequency, duration and intensity. It can also help ease menopausal symptoms such as low mood and poor sleep. It effectively targets the vicious cycle so symptoms become more manageable and mood improves”.⁶

“There are many dietary supplements available over the counter and advertised as remedies for relief of hot flashes and night sweats. There are limited studies showing that these supplements are effective at relieving VMS, and there is a lack of government regulation ensuring their safety and purity, so none of these are recommended treatments for hot flashes and night sweats.

Despite the lack of evidence supporting their use for VMS, if you plan to use dietary supplements, let your health care professional know so they can ensure they are safe for you, that they don’t interact with any of your medications, and so that they can be appropriately monitored”.⁷

“Some antidepressants have been shown to relieve hot flushes. For example, venlafaxine, paroxetine, escitalopram and fluoxetine. Side effects may include nausea, dry mouth, hot flushes, sweats and insomnia.

Note that paroxetine and fluoxetine can reduce the effectiveness of some cancer treatment medicines”.⁸

“The U.S. Food and Drug Administration approves only one treatment that doesn’t use hormones for hot flashes. The treatment is a low-dose form of paroxetine (Brisdelle).

Other antidepressants that have been used to treat hot flashes include:

• Venlafaxine (Effexor XR)
• Paroxetine (Paxil)
• Citalopram (Celexa)
• Escitalopram (Lexapro)

Antidepressants don’t work as well as hormone therapy for strong hot flashes. But they can help people who can’t use hormones. Possible side effects include nausea, trouble sleeping or feeling sleepy, weight gain, dry mouth or trouble having sex”.⁹

“Other medicines that might offer relief for some people include:

• Gabapentin (Neurontin, Gralise, Others). This antiseizure medicine helps ease hot flashes. Side effects can include being drowsy, dizzy or tired and swelling in the arms and legs, called edema
• Pregabalin (Lyrica). This is another anti-seizure medicine that can help ease hot flashes. Side effects can include being drowsy and dizzy, having trouble focusing, and gaining weight
• Oxybutynin (Oxytrol). This is a pill or patch most often used to treat urinary conditions like overactive bladder. It also may help ease hot flashes in some people. Side effects can include dry mouth, dry eyes, having nausea, and being constipated and dizzy
• Clonidine (Catapres-TTS 1, Nexiclon Xr, Others). This pill or patch mostly used to treat high blood pressure, might give some relief from hot flashes. Side effects include being dizzy, drowsy and constipated and having a dry mouth
• Fezolinetant (Veozah). This daily pill treats menopause hot flashes without hormones. It works by blocking a pathway in the brain that helps to manage body temperature”.¹⁰

• “The use of compounded bioidentical hormone replacement therapies is not recommended given the issues related to their purity, potency and safety. The potential benefits of bioidentical hormone therapy can be achieved using conventionally licensed products available through NHS prescribing without having to resort to compounded varieties from specialist pharmacies”.¹¹

“A procedure called a stellate ganglion block has shown promise for treating moderate to strong hot flashes. It involves shooting a numbing medicine into a nerve cluster in the neck”.¹²

“Lifestyle medicine – encompassing healthy eating, physical activity, mental well-being, avoidance of risky substances, restorative sleep and healthy relationships – offers a promising non-pharmacological strategy to optimize health during this period”.¹³

“Results: Lifestyle medicine interventions were associated with reductions in vasomotor symptoms, improved sleep quality, enhanced mental well-being, healthier weight regulation, and reduced cardiometabolic and osteoporosis risk”.¹⁴

• “What do you think are possible triggers for my hot flashes?
• Are there any lifestyle or dietary interventions that may diminish my symptoms?
• Should I consider medication for treatment of my symptoms? Hormonal or non-hormonal?
• If you are interested in hormonal therapy: Am I a good candidate for hormonal therapy, specifically are my cardiovascular and breast cancer risks low?
• Which lifestyle changes can I make that will decrease my menopause symptoms without medicine?
• Are there any alternative medicine treatments you would recommend I try for relief of my menopause symptoms?
• Are there any alternative medicines I should not use because they could interfere with medicines I take?”¹⁵

“One of the powerful messages coming from the NICE Guideline is that herbal remedies which are not regulated by a medicine authority should not be considered safe, as there is much variety in their effectiveness and potency and there may be significant side effects or interactions. The same warning is given for compounded bioidentical hormone therapy which is not regulated or subject to the same quality control as conventional HR”.¹⁶