The SWAN study – a large cohort study of women transitioning through menopause –  found that 60-80% of women experience hot flashes at some point during the menopause transition. This includes the perimenopause period, or the years leading up to menopause. 

“So you get hot for a few minutes, what’s the problem?” 

People who haven’t had hot flashes have no idea how uncomfortable and disruptive they can be, causing sweating, rapid heartbeat and anxiety. The Cleveland Clinic categorises hot flashes into mild, medium and severe:

Mild is one to four hot flashes per day, with little disruption to your everyday life. 

Medium is up to eight hot flashes per day. If you fall into this category, you may be able to get by with lifestyle changes and symptom management or possible you may discuss treatments with a healthcare provider.

Severe is anything more than 12 hot flashes a day. At this point, many women find the hot flashes to be disruptive and are looking seriously at all the options.

What if I can’t have hormone therapy or I don’t what it?

If you’re in the medium to severe categories and you and/or you and your doctor have excluded hormone therapy as an option (there could be a number of reasons why this is contraindicated), what are the non-hormone options?

Pharmacological/Prescription Options

Paroxatine: This is an SSRI (selective serotonin reuptake inhibitor) typically used as an antidepressant, and is the only non-hormone medication approved by the FDA for reducing vasomotor symptoms (VMS) or hot flashes. Other SSRI’s that show evidence in large randomised control trials (RCTs) to reduce VMS include citalopram, escitalopram, venlafaxine and desvenlafaxine.

Gabapentinoids: A drug traditionally used as an anti-epileptic, though evidence from large RCT’s shows that Gabapentin reduces VMS.

Non-Pharmacological Options: 

Cognitive-Behavioural Therapy: This is one of two mind-body techniques that has evidence for efficacy in alleviating VMS. Two rigorous RCT’s showed it to be effective in helping survivors of breast cancer and peri- and post-menopausal women without cancer to manage their VMS. This intervention has additional benefits in mood, quality of life, and overall functioning. In addition, clinical hypnosis is a mind-body technique that has been shown to alleviate VMS.

Adaptogen Options:

There are small studies (and therefore not strong evidence until we have large RCT that are done) that show the benefit of adaptogens in assisting in the menopause transition. 

— Rhodiola: Shown to have SERM effect (selective estrogen reuptake modulator) and so mitigating menopausal related cognitive, psychological and cardiovascular changes. Improves sleep and fatigue.

— Red Peruvian Maca (in early perimenopause): Has been shown to be effective in alleviating symptoms. RCT’s have shown improvements in anxiety and mood symptoms. 

— Siberian Ginseng: stress protective, useful in chronic fatigue syndrome. 

— Ashwagandha: Protects against stress, anti-anxiety, anti-depressant, immune modulation 

— Reishi Mushroom: Increases the sensitivity of estrogen receptors, and so reducing vasomotor symptoms. Calming effect, improves sleep, immune modulation.

I would highly recommend chatting to your doctor before making these decisions alone, even if you’re considering adaptogen options. Here at Hanya House, both myself and Dr. Allison van der Riet have experience and special interest in hormone health.

Dr. Rav James is a medical doctor and functional medicine specialist. Dr. Rav is a member of The Menopause Society and is currently studying to be a Menopause Society Certified Practitioner (MSCP). Dr. Rav has experience using menopause hormone therapy as well as non-hormone management of menopause and other mid-life healthcare issues. To contact Dr. Rav James, contact 068 494 6621.