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“The pharmacist”
Good against hot flashes – the best active ingredients from nature for the menopause
Hormone replacement pills aren’t the only remedies for hot flashes. Our author and pharmacist Diana Helfrich knows that many herbal active ingredients also have a good effect
© Photo: Henning Kretschmer; Illustration: Michel Lengenfelder
Menopause usually does not play a major role in the pharmacy. There are at least a number of over-the-counter remedies and ways to relieve or reduce hot flashes.
It’s a pity that so little is talked about it, because in the drawers of the pharmacies there are quite a number of over-the-counter helpers against hot flashes and the other annoying possible complaints of the transition period. Above all those with the black cohosh (Cimicifuga racemosa or Actaea racemosa). It is the menopause classic among medicinal plants. In the current guideline, however, it only appears as a “can” recommendation: Cimicifuga CAN be used for vasomotor symptoms (i.e. hot flashes), a benefit is possible. Various studies have shown a significant improvement in vasomotor and psychological menopausal symptoms compared to placebo, in some cases comparable to low-dose hormone therapy. But you have to be honest: Overall, the data is not nearly as good as with hormones.
According to the guideline, only approved Cimicifuga drugs and no dietary supplements should be recommended. Pharmacists like to hear that, because the medicines are only available in pharmacies. But even with these, black cohosh is not just black cohosh. According to the guideline, the preparations for which the extract from the root was obtained with the solvent isopropanol are the best. Consult your doctor or pharmacist, also about possible side effects on the liver.
Black cohosh is also available in combination with St. John’s wort, a herbal antidepressant. It wasn’t until I was researching my menopause book (“Menopause – I thought I couldn’t get it!”, published by Mosaik in 2021) that I realized that it might not just be about doing something good for the mood. As is well known, this can fluctuate even if the estrogen levels fluctuate greatly during menopause. As is now known, some chemically-synthesized antidepressants also have an effect on hot flashes, via brain chemistry. In the USA, a low-dose antidepressant is approved as a remedy for hot flashes.
Help during menopause: Phytoestrogens are found in many foods
The second important group is that of phytoestrogens. These are plant compounds that can bind to estrogen receptors. However, the bond is less stable than with the actual estrogens, which is why they have a much weaker effect. Phytoestrogens are found in many foods, in very healthy foods such as flaxseed or legumes, but also in tablets. Ten years ago, the renowned Cochrane Collaboration devoted itself to the topic of “phytoestrogens against hot flashes” and critically evaluated the studies available at the time. Accordingly, the effect is not convincing, the phytohormone genistein appears to be the most promising, at a dosage of 30 to 60 milligrams a day.
But if you lower the bar significantly and look at individual studies, even if they are small and often supported by the manufacturer, things look much better. Numerous works provide evidence of good effectiveness, such as that of rhapontic rhubarb, which has become more popular in recent years: over the course of twelve weeks, it reduces hot flashes just as well as very low-dose hormone therapy.
Incidentally, the following applies to all the herbal remedies mentioned: You should keep your trusted gynecologist up to date, and anyone who has ever had breast cancer needs good medical advice beforehand.
Then there are a few other over-the-counter remedies or methods that have been proven to do a lot. Examples include cognitive behavioral therapy and hypnosis. You can’t get either of these in pharmacies (and these methods aren’t readily available in Germany anyway), so here’s just this much: According to studies, hypnosis is the next best thing after hormones when it comes to hot flashes: It can reduce their frequency by an incredible 82 percent – if you want to know more, can listen to the MENO AN MICH podcast episode, for which I worked with the Kiel gynecologist Dr. Dorothee Struck spoke. Cognitive behavioral therapy – where you learn to deal with the symptoms differently in discussions and exercises – also helps reliably, but only reduces the suffering from the hot flashes, not their frequency.
With behavioral therapies against hot flashes
It can also alleviate depressive episodes, sleep disorders and sexual problems during menopause. Also all things that can get you down but for which there is no biological marker. They always depend on our evaluation. There is a book by Myra Hunter, a Professor of Clinical Health Psychology at London’s Kings College, with a four-week behavioral therapy self-help program for hot flashes that has done well in her studies.
But don’t get me wrong: I have nothing against hormones! Just so much here: A capsule with the female sex hormone progesterone in the evening can be extremely helpful if sleep is poor due to the relative lack of progestin at the beginning of the menopause. And as far as estrogens are concerned, I would even say that too many women still do not take any: Around a third have severe menopausal symptoms, according to the general estimate, and only around six percent take hormone replacement therapy or HRT, according to figures from Techniker Krankenkasse. It is very often the appropriate treatment for this third, nothing better helps against hot flashes, which can be so, so grueling.
Modern preparations have fewer side effects
But the fear of side effects runs deep. Too many patients and doctors still remember the data from a good 20 years ago, according to which hormones trigger heart attacks, strokes, breast cancer and much more. But that has changed, not least with the modern active ingredients (the bioidentical hormones, these are exactly the ones that the body also produces). If you do it cleverly – and this includes administering the estrogens through the skin – after several years of treatment, the three side effects mentioned above “only” leave a certain risk of breast cancer. Every woman has to decide for herself whether she accepts it after she has informed herself well. That includes knowing that there are a few more treatment options… including at the pharmacy. You can read more about homon replacement therapy in my other column on menopause.
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Note: The column can neither replace individual advice in the pharmacy nor the package insert or medical diagnosis and treatment.