Complementary Treatments for Vasomotor Symptoms
| Intervention | Efficacy | Precautions | Notes |
|---|---|---|---|
| Black Cohosh Cimicifuga acemose | Possibly effective49,50,51 | Rare but potential liver toxicity; consider monitoring liver enzymes or avoiding in liver disease; Estrogen receptor stimulation seems unlikely,52,53 but not definitively safe in high risk hormone responsive cancers | Common dose is 20-40 mg twice daily of a standardized extract; Possible SERM-like activity; also thought to have anti-inflammatory and SSRI activity leading to potential to also help with aches/pains and mood related to perimenopause54 |
| Soy Glycine max | Possibly effective59,60 | Phytoestrogen | Products that contain at 15 mg-30 mg of the soy isoflavone genistein more consistently effective61; Genistein content in foods: ½ c miso—32 mg 3 oz uncooked tempeh: 30.7 mg 3 oz cooked tempeh: 18 mg 1 oz dry roasted soybeans: 21.2 mg 3 oz soft tofu: 10.1 mg ½ cup edamame: 6.3 mg 1 cup low fat soy milk: 3.7mg62 |
| Siberian Rhubarb Rheum rhaponticum | Possibly effective55 | Use root; leaf can be toxic May activate estrogen receptor beta, but not alpha | Studied dose is 4 mg of a dried extract, once daily. May also help with anxiety, sleep, mood, quality of life, fatigue |
| Sage Salvia officinalis | Possibly effective56,57 | Recognized as a food In very high doses may be toxic due to thujone constituent58; alcohol extracts have higher thujone content than water infusions (tea); Possibly weak estrogen activity | Consider 1tsp of dried sage 2 to 3 x daily steeped in 1 cup near-boiling water for 7 to 10 minutes then strained |
| Red Clover Trifolium pratense | Insufficient reliable evidence63,64 | Phytoestrogen | 80 mg of dried leaves and 80 mg of standardized extract have both been studied |
| Yoga | Possibly effective65,66 | Caution in patients with hypermobility syndromes or osteoporosis | May also help with psychological symptoms; practices that include meditation and breathwork may be better than hot yoga |
| Acupuncture | Insufficient reliable evidence67,68 | Improves VMS over no treatment, but not over sham acupuncture (debate over “sham” acupuncture as true control is problematic in acupuncture literature in general) May be an appropriate adjunct to improve overall quality of life | |
| Hypnosis | Likely effective69 | Use with caution or avoid in those with history of trauma or abuse and with active psychosis | Professionals trained in clinical hypnosis can be found at: Available at: https://www.asch.net/aws/ASCH/pt/sp/find-member |
| Mindfulness, CBT, behavior therapies | Possibly effective70,71 | Therapies may decrease negative experience or interference of hot flashes but not necessarily frequency. A specific protocol CBT for menopausal symptoms (CBT-Meno) may be more efficacious (study compared to waitlist). |
Abbreviations: SERM, Selective Estrogen Receptor Modulator; SSRI, Selective Serotonin Reuptake Inhibitor; VMS, Vasomotor Symptoms; CBT, Cognitive Behavioral Therapy.