Hot flashes—a review of the literature on alternative and complementary treatment approaches

Alternative Medicine Review, August, 2003 by Hazel A. Philp

Two double-blind, randomized, controlled trials involving a total of 100 menopausal women evaluated, via a symptom checklist, the ability of Promensil (40 mg) to manage hot flashes. The red clover extract was not found to be significantly more effective than placebo, (85,86) nor did the groups differ in vaginal cytology, endometrial thickness as measured by ultrasonography, or serum hormone levels.

Currently it is unknown whether long-term use of red clover would have an estrogenic effect on the human female breast or endometrium, but data suggest it is weakly estrogenic in the ovariectomized rat model. (87) Because of the presence of coumarins in some clover species, including Trifolium pratense, tests of clotting factors in future trials may be prudent. (83) In addition, red clover has been shown to improve systemic arterial compliance and elasticity in postmenopausal women, (88) potentially decreasing risk of cardiovascular disease. (3) Currently there are several larger trials of red clover in progress.

Wild Yam (Dioscorea villosa)

Topical wild yam and progesterone creams, readily available over-the-counter, are promoted for menopausal symptoms, including hot flashes. (89) While one of the components in wild yam, diosgenin, can be converted in the laboratory to steroidal compounds including progesterone, this synthesis does not occur in the human body. (90) Therefore, patients need to be advised that wild yam extract will not increase their progesterone levels. (91,92) Wild yam may have some estrogenic activity, but this possibility has not been adequately investigated. (93)

A double-blind, placebo-controlled, cross-over study tested the effects of a wild yam cream against placebo for three months in 23 healthy women complaining of menopausal symptoms, including hot flashes. (94) Both the treatment and placebo groups improved slightly in subjective experience of hot flashes and night sweats, but there were no changes from baseline in FSH, estradiol, or serum or salivary progesterone. Additional baseline measures, including body weight, blood pressure, levels of serum total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, and glucose did not change.

Dong Quai (Angelica sinensis)

Dong quai is an herb native to Eastern Asia and China, used for more than 2,000 years as a tonic, spice, and medicine in traditional Chinese medicine (TCM). It is known as the "female ginseng" and is currently the second-best selling herb in China. (95) Traditionally it has been indicated for menstrual disorders, as a supportive herb for menopausal complaints, (96) and for its vasodilatory and antispasmodic effects. (3) Its effectiveness in relieving hot flashes may be due to a combination of a mild estrogenic effect and other components acting to stabilize blood vessels. (97) Dong quai contains ferulic acid, (98) which has also been shown to decrease hot flashes. (99,100)

A randomized, double-blinded, placebo-controlled study of 71 postmenopausal women evaluated the effectiveness of 4.5 g dong quai or placebo daily. (101) Menopausal symptoms (i.e., hot flashes and vaginal atrophy) decreased to a similar degree in both the treatment and control groups, and the dong quai did not cause endometrial thickening or an increase in the vaginal maturation index. In addition, estradiol, estrone, and sex hormone-binding globulin levels were unchanged by the dong quai treatment. Dong quai was well tolerated and no serious side effects were noted.