While menopausal hormone therapy (MHT) remains the most effective treatment for menopause related vasomotor symptoms, not everyone can or wants to take it, and on its own it may not be enough to do the job. This leaves many women asking: “what else can I do?”
There’s no shortage of lifestyle and mind-body strategies purported to relieve or reduce hot flushes and night sweats—but which ones live up to the claims?
The Menopause Society (formerly the North American Menopause Society, or NAMS) has recently updated its position statement, after reviewing the evidence for a host of nonhormone therapies, and some of the results may surprise you.
The panel assessed the current literature to determine whether or not to recommend each therapy, based on three levels of evidence:
• Level I, good and consistent scientific evidence
• Level II, limited or inconsistent scientific evidence and,
• Level III, the lowest form made up of consensus and expert opinion.
While the position statement makes recommendations based on the level of evidence, some of these interventions may still be worth trying, as they are inexpensive and don’t cause harm, says Dr Marita Long, a GP and board member for the Australian Menopause Society.
“Remember we do need more research,” she says. “It’s good to be able to inform women what there is and isn’t evidence for, but it’s also important to keep in mind that things like layering clothes are cheap and can’t cause harm, so don’t throw baby out with bathwater, so to speak.”
In this article, we’ll sum up the Menopause Society/NAMS findings on lifestyle strategies and mind body techniques, and future articles will cover supplements and nonhormone prescription medicines.
As hot flushes can be triggered by a small change in core-body temperature, the panel agreed there was a logic behind the idea of dressing in layers, using fans, placing cooling pads into the bed or a cold compress on the forehead, but in the end the studies weren’t sufficiently robust to support their use.
Avoiding “triggers” such as alcohol, caffeine, spicy foods, or hot foods or liquids is commonly suggested as a way of avoiding hot flushes, but the panel found conflicting evidence on alcohol and no clinical trials assessing the effects of avoiding other triggers for the alleviation of vasomotor symptoms.
The health benefits of exercise are well established, but when it comes to vasomotor symptoms, it’s not so clearcut, the panel found.
Some observational studies found that women who exercise regularly report fewer vasomotor symptoms, but others found that exercise may trigger flushes.
The studies often compared different exercise methods or made comparisons with supplements. Many of the studies, especially when it came to yoga, relied on self-reported data and exhibited bias.
“Although there are other health benefits associated with exercise or yoga, the evidence of those interventions for the treatment of [vasomotor symptoms] VMS is sparse,” the panel concluded.
There is a lot of talk about the benefits of plant-based diets or increasing soy in the diet to help with vasomotor symptoms, but the panel found limited research evaluating this.
Various small studies have looked at soy and plant-based diets and found a reduction in vasomotor symptoms. Other studies have shown that high fat, high sugar, diets may increase them—as may eating poultry and skimmed milk products—but there is not enough evidence to recommend this strategy.
The panel concluded “there is limited evidence from clinical trials to support the use of dietary modification for improving [vasomotor symptoms] VMS.
The panel concluded that more rigorous studies are needed to determine if weight loss can improve vasomotor symptoms. Many of the studies which showed benefits for vasomotor symptoms were either small pilot studies, were not randomised or were post-hoc analyses of studies designed for a different purpose. Because of that, they’ve given it a Level II-III, but the NAMS medical director told Healthed “the expert panel decided evidence was sufficient to recommend weight loss for [vasomotor symptoms] VMS.”
The theory behind CBT to help with vasomotor symptoms centres on changing the way we perceive and deal with them. The panel said CBT has been shown to reduce the degree to which these symptoms are rated as a problem, concluding that “the body of literature as a whole supports that CBT alleviates bothersome [vasomotor symptoms] VMS for both survivors of breast cancer and menopausal women.”
Mindfulness-based interventions involve accepting bodily changes in a non-judgemental manner. They also include mindfulness-based stress reduction which involves mediation, body awareness and yoga. The panel noted that a number of small studies showed improvements in how much vasomotor symptoms bothered the participants, but they said “these studies were limited by their small sizes or limited control groups and that they were not designed to consider [vasomotor symptoms] VMS (e.g. women with VMS were not specifically enrolled).”
They concluded that until some rigorous studies are done, there isn’t enough data to recommend mindfulness-based interventions or mindfulness-based stress reduction techniques for the management of vasomotor symptoms.
Clinical hypnosis, a mind-body therapy that involves a deeply relaxed state, individualised mental imagery and introduced suggestions, has been widely used to manage other chronic symptoms such as pain and anxiety.
Hypnosis has been studied for the treatment of hot flushes and the panel is giving it the thumbs up, provided it’s delivered by an appropriately trained practitioner. The studies showed it helped reduced the number and frequency of hot flushes.
Paced respiration – taking six to eight slow deep breaths through the nose and exhaling through the mouth, is “unlikely to provide any benefit for hot flashes” the panel decided, despite many claims to the contrary.
While several small studies showed it reduced hot flushes, other studies showed it was not better than normal breathing.
One study “showed that women who used a chest device to guide their slow, deep breathing practice at home for at least 15 minutes per day had significantly less benefit than a control group assigned to music listening,” they wrote.
Again, the panel found that evidence is limited, inconsistent and insufficient. “Limitations across studies included small sample sizes or lack of an appropriate attention-control group.
Based on this educational activity, complete these learning modules to gain additional CPD.
Listen to expert interviews.
Click to open in a new tab
Browse the latest articles from Healthed.
You have completed the Educational Activities component of this resource.
Select ‘Confirm & claim CPD‘ to confirm you have engaged with this resource in its entirety and claim your CPD.
You will be taken to explore further CPD learning available to you.
