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Unsure about HRT or confused about complementary therapies? A recent report fromm the respected North American Menopause Society (NAMS) reviewed all the evidence for non-hormonal therapies and their effect on hot flushes and night sweats.
Only Cognitive Behavioural Therapy (CBT), including advice on relaxation and sleep hygiene (things like winding down before bed, going to bed at the same time), clinical hypnosis or hypnotherapy and some low-dose antidepressants, and other precibed non-hormonal drugs (which require specialist advice, see the chart opposite) get the NAMS seal of approval. Consultant gynaecologist Professor Janice Rymer of King's College London, comments, "We don't know the mechanism by which these work because we don't really know what causes flushes. Howeve, what they seem to have in common is that they all act on the nervous system." This fits with current thinking that, although the dip in oestrogen at menopause is somehow responsible, an over-reactive autonomic nervous system that controls things like breathing, heart rate, sweating and the fight-and-flight reflex, may be the immediate underlying cause.
Could Be Worth A Try
A cautious thumbs up goes to isaflavones, plant chemicals found in soya beans, soya milk and tofu, and isoflavone supplements such as red clover. The only snag is that they don't work for everyone. Your gut bacteria have to be able to convert isoflavones into an active chemical called equol. If you're not an equol produce, you may still be plagued by flushes, no matter how much soya milk you quaff or how many supplements you take. Weight loss and mindfulness-based stress reduction could also help, says NAMS, although the evidence isn't cast iron.
What Doesn't Work
Perhaps suprising to the many who swear by them, NAMS concludes that yoga and acupuncture do nothing to quell flushes. Avoiding trigger factors like hot rooms, alcohol and caffeinated drinks don't reduce the number of flushes either. Even aerobic exercise gets a thumbs down, although of corset has myriad other benefits at midlife.
Unlikely to work
Herbal remedies such as Black Cohosh, thought to work by blocking oestrogen receptors, and the Chinese herb Dong Quai , which has question marks over safety, were also rejected by NAMS. Chriopractic and nutritional supplements such as linseeds (flax), which contains oestrogen-like chemicals, evening primrose oil, omega 3s, vitamins, minerals and pollen, are also dismissed on grounds of inadequate evidence.