Hot flashes revisited: pharmacological and herbal options for hot flashes management. What does the evidence tell us?
BACKGROUND
Hot flashes are the most frequent symptoms of menopause and the most common reason for climacteric women seeking medical advice. Estrogen therapy is by far the most effective therapy. However, fears of side-effect of estrogen therapy urged many patients to seek alternative modalities for symptomatic relief.


METHODS
The MEDLINE database for the years 1975-2004 was searched for clinical placebo-controlled trials for the treatment of hot flashes with alternative therapy. Articles reporting the use of progesterone, alpha adrenergic agonists, anti-depressants, anti-convulsants, soy products, black cohosh (BC), red clover, dong quai, ginseng root, evening primrose oil, vitamin E, and wild yam were included.


CONCLUSIONS
A critical review of the literature shows that progesterone may have an independent effect on relieving hot flashes. New nonhormonal agents such as selective serotonin-uptake-inhibitor anti-depressants and a new anti-convulsant gabapentin yielded promising results on small well-conducted studies. Isoflavone's effect on hot flashes is variable and inconsistent, and only modest and delayed improvement of symptoms could be expected by BC and vitamin E. There are insufficient data on the other herbal alternative therapies at this time. Well-designed large studies are needed to further explore new modalities of treatment.
Haimov-Kochman
Ronit
R
Department of Obstetrics and Gynecology, The Division of Reproductive Endocrinology and Infertility, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel. rkochman@itsa.ucsf.edu
Hochner-Celnikier
Drorith
D
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D005260:Female; D019584:Hot Flashes / Q000188:drug therapy*; D006801:Humans; D008593:Menopause; D008517:Phytotherapy; D010936:Plant Extracts / Q000627:therapeutic use*; D010946:Plants, Medicinal
D000316:Adrenergic alpha-Agonists; D000927:Anticonvulsants; D000928:Antidepressive Agents; D010936:Plant Extracts