Despite avid interest in finding nonhormonal therapies for menopausal hot flashes, most alternative treatments have demonstrated only limited efficacy, and their safety remains in question, according to a systematic review of the literature.
Dr. Heidi D. Nelson and her associates at Oregon Health and Science University, Portland, compared all randomized, placebo-controlled trials of nonhormonal treatments for hot flashes with the efficacy and adverse effects of agents other than estrogens, progestins, progesterone, or androgens (JAMA 2006;295:2057–71).
A metaanalysis was conducted using 24 of 43 selected studies. Overall, there was some evidence that selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), clonidine, and gabapentin reduce the severity and frequency of hot flashes. However, none of these agents approached the effectiveness of hormone therapy, Dr. Nelson and her associated noted.
The evidence for soy isoflavone extracts was contradictory, “even among the largest and highest quality trials,” they noted. There was no evidence to support the efficacy of red clover isoflavone extracts.