Options for managing hot flashes without hormones

Oct 17, 2023
Key Takeaways
  • Menopause treatment can be a trial-and-error process; exploring non-hormonal options may be necessary due to personal preferences or health conditions.
  • Mindfulness practices such as listening to music and paced respiration (slowing breathing rate) have shown reductions in hot flash frequency by up to 35% and 21% respectively.
  • A low-fat, plant-based diet with soy protein has been proven to reduce hot flashes significantly.

Estrogen therapy is the most effective treatment for relieving menopause symptoms, like hot flashes. Some patients may opt to try non-hormonal treatment options, because of either personal preference or they may be unable to utilize hormone replacement therapy due to a past or current health condition.

While we wish there was a singular remedy that could give you relief, medical studies show that treatment for menopause can be a trial and error process. 

When it comes to non-hormonal treatment options for menopause we want to be honest and forthright about the evidence to date. Research is always investigating new therapies, so let’s go over which strategies are worthy of your attention. We want to ensure that you are an informed consumer, so we will also highlight the risks and contraindications of popular treatments. [1]

Strategies for managing hot flashes

There are several lifestyle strategies that can help mild to moderate hot flashes. These include lowering room temperature, using fans, dressing in layers of clothing that can be easily removed, and trying to moderate stress. [1] 

Managing hot flashes with mindfulness

Promising mindfulness techniques include listening to music and practicing “paced respiration”. Paced respiration is the practice of slowing your resting breathing rate to less than 10 breaths per minute for at least 15 minutes every day. [2]

Listening to music and paced respiration produced up to a 35% and 21% reduction in the frequency of hot flashes, respectively. These strategies may reduce the stress response associated with hot flashes.

Managing hot flashes with dietary changes

Incorporating more food that contains phytoestrogens into your diet can also be an effective way to manage hot flashes. Low-fat, plant based diets are high in phytoestrogens and have been proven in trials to significantly reduce hot flashes. Phytoestrogens are estrogen-mimicking in the body, which helps reduce menopause symptoms.

Food sources that contain phytoestrogens include soy (tofu, tempeh, edamame, and soy milk), flaxseed, lentils, and chickpeas. These whole foods provide fiber and plant-based protein, which have also been shown to reduce the risks of diabetes, cardiovascular disease, and hypertension. Aim to incorporate 15 to 25 grams of soy protein daily, unless otherwise directed by your healthcare provider. [5]

The recent trial by Women’s Study for the Alleviation of Vasomotor Symptoms (WAVS) demonstrated that a low-fat, plant-based diet that incorporates ½ cup of soybeans daily significantly reduces hot flashes. Women reported a 79% reduction in total number of hot flashes; with an even more impressive 84% reduction of moderate-to-severe hot flashes. This is a promising whole-food approach for relief, especially if hot flashes or night sweats are your most bothersome symptom. [6]

Additionally, women following a Mediterranean dietary pattern report a 20% reduction in their vasomotor symptoms. The intake of fatty fish, a good source of omega-3 fats and vitamin B6, has also been associated with less severe hot flashes [3]. Don’t like fish? Omega 3 supplements have also been shown to reduce the frequency and severity of night sweats [4]. Other dietary strategies include moderation of caffeine, alcohol, hot and spicy foods. 

What if I'm not seeing any changes from a plant-based diet?

Not all women metabolize phytoestrogens the same way. Approximately one-third of women have gut microbes capable of metabolizing the phytoestrogen daidzein to an active metabolite, equol. This means that some women are more likely to experience improvements in their menopausal symptoms than others through nutrition or supplements.

If you do not experience relief from whole soy foods or genistein isoflavone supplements, you may consider talking to your healthcare provider about equol supplementation [9]. The Natural Medicine’s Database indicates that 30 mg of equol has been used safely in studies lasting up to 12 weeks. The most common side effects include abdominal distension and constipation. Because equol may also have estrogenic effects, consult your healthcare provider before use.

Herbal remedies for hot flashes

Plant-based therapies and herbal remedies fall somewhere in between; due to the inconsistent evidence to effectively reduce the number and/or severity of hot flashes. These include the popular dietary supplements of: Phytoestrogens, Black Cohosh, and Vitamin E

Phytoestrogen supplements

Many popular supplements isolate the active ingredients in phytoestrogen-rich foods. Most common are the isoflavones, daidzein, and genistein, from either soy or red clover.  If you decide to explore isoflavone supplements, research suggests that 50 to 100 mg/day is generally appropriate. [5,7,8]

Of these isoflavones, genistein holds the most promise for improving hot flashes for menopausal women. [1] To date, red clover has not been shown to be as effective.

Although phytoestrogens are much weaker than the estradiol produced by our ovaries, many experts agree that concentrated supplements should be avoided by women with a history of breast cancer or any other hormone-related health concerns until their safety has been established. [1]

Black cohosh and Vitamin E

Black cohosh is an extremely popular supplement to moderate menopausal symptoms, although clinical trials have not shown consistent benefits. While black cohosh does not increase circulating estrogen, it has both estrogenic and anti-estrogenic effects in the body by acting on selective estrogen receptors.

Black cohosh can often be found under the name Remifemin. Similar to isoflavone and equol supplements, there are concerns that black cohosh could stimulate breast tissue like estrogen. Until we have more research, experts suggest that women with breast cancer or other hormone-related concerns also avoid black cohosh. Black cohosh also interacts with the medications Lipitor and Cisplatin. Talk with your doctor if you are taking these medications. [1]

Vitamin E has been shown to marginally improve hot flashes. Because vitamin E is generally well tolerated and safe, it may provide another therapeutic option. It is important to note that high doses of vitamin E can increase your risk of bleeding. [1]

Dietary supplements or hormone replacement therapy?

Are supplements as effective as hormone replacement therapy? Phytoestrogens, herbs, and other dietary supplements haven’t been clearly shown to relieve menopause symptoms. While some research suggests benefits, interpretation is difficult because of the small size and short duration of many studies.

Any benefits are likely attributable to a “placebo effect”, which is still noteworthy as it relates to creating a stronger connection between the brain and body.

For more information on hormone replacement therapy, read our blog: Is hormone replacement therapy safe?

Dietary supplements may have side effects or interact with drugs, and little is known about their long-term safety. Dietary supplements are not regulated by the U.S. Food and Drug Administration. Many products vary in safety, effectiveness, purity and levels of active ingredients.

Consumer Information

Always discuss any supplements with your healthcare provider before using. Several dietary supplements interact with prescription medications. You want to ensure that the supplement is appropriate for you.

Since research has been inconsistent and limited on dietary supplements, it is best to reference the evidenced-based summaries published by trusted organizations such as the North American Menopause Society and the National Institutes of Health’s (NIH) Center for Complementary and Integrative Health.

Medical resources also include UpToDate, Natural Medicines Database, and the National Institutes of Health’s Office of Dietary Supplements.

We recommend that you consult with your health professional as they can review the efficacy, safety, and appropriateness of various supplements specific to your symptoms and health history.

Check to see if your supplement is approved by the U.S. Pharmacopeial Convention (or USP), a nonprofit group that verifies the contents and safety of dietary supplements at the request of the supplements’ manufacturer. 

You can look for the USP seal on the supplement bottle or check the USP website that lists the approved and regulated brands. Consumer Lab also conducts independent quality reviews of dietary supplements. You can also look for the CL seal to identify products that have met their testing standards or access information at https://www.consumerlab.com.

  1. Santen et al., Menopausal Hot Flashes; UpToDate, updated 10/24/22
  2. Huang et al. Device-guided slow-paced respiration for menopausal hot flushes: a randomized controlled trial. Obstet Gynecol. 2015 May; 125(5): 1130-1138)
  3. Odai et al. Severity of hot flushes is inversely associated with dietary intake of vitamin B6 and oily fish. Climacteric. 2019 Dec;22(6):617-621)
  4. Mohammady et la. Effect of omega-3 supplements on vasomotor symptoms in menopausal women: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2018 Sep;228:295-302
  5. Messina et al. The health effects of soy: a reference guide for health professionals. Front Nutr. 2022; 9: 970364)
  6. Barnard et al. The Women's Study for the Alleviation of Vasomotor Symptoms (WAVS): a randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women. Menopause 28(10):p 1150-1156, October 2021)
  7. A Nutraceutical Approach to Menopausal complaints; Medicina, 2019 Sep; 55(9)
  8. Chen & Chen, Utilization of Isoflavones in soybeans for women with menopausal syndrome: an overview; Int J Mol Sci. 2021 Mar; 22(6):3212
  9. Daily et al. Equol Decreases Hot Flashes in Postmenopausal Women: A Systematic Review and Meta-Analysis of Randomized Clinical Trials J Med Food. 2019 Feb;22(2):127-139
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