The first alternative to hormone therapy for treating hot flashes should be a lifestyle approach, such as instituting an exercise regimen or practicing controlled breathing techniques.

Observational studies have shown that lowering air temperature reduces hot flashes. Some other methods that women can use to keep cool include using a fan, dressing in layers so clothes can be removed easily, and consuming cold foods and drinks while avoiding hot ones. While exercise can cause women to perspire and can elevate core body temperature, studies have shown that fit women experience as many as 50% fewer hot flashes than age-matched sedentary women. A high body mass index is associated with more frequent and severe hot flashes, which provides some rationale for using weight loss as an approach to treatment. In addition, women who smoke experience more hot flashes. Paced breathing appears to be the most effective of the relaxation-type techniques studied with 50% fewer hot flashes.

Clinical trials of the common nonprescription remedies that some women try have mostly shown no efficacy, or various conflicting results. Since alternatives such as Vitamin E, isoflavones, and black cohash appear to have little potential for adverse effects, they can be an option, particularly since many women feel a definite benefit. Isoflavones, or phytoestrogens, come from two common sources, soy and red clover. One Japanese study reported that the 30%-50% of women who convert the daidzein contained in soy into equol, a non-steroidal estrogen, are more likely to have benefit than women who do not. However, a recent randomized, controlled trial found no benefit from soy. Therefore, we recommend that you try an over the counter product like Soy Menopause or Black Cohash to take it one to three times a day and if it works for you, continue!