Hot flashes and night sweats (vasomotor symptoms [VMS]) are exceedingly common during the menopausal transition, affecting up to 80% of women. A variety of botanical medicines and phytonutrients are popularly used to address VMS. These include soy isoflavones, black cohosh, flaxseed lignans, red clover extracts, and Siberian rhubarb. This article reviews the evidence for the use of these botanical medicines or phytonutrients in addressing menopausal hot flashes. Safety and adverse effects are also discussed. By and large, these botanical medicines have been found to be both safe and efficacious for menopausal VMS.
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References
1.
BhupathirajuSN, MansonJE. Hot flashes and the heart: An ongoing enigma. Menopause, 2017; 24:871–873.
2.
ThurstonRC. Vasomotor symptoms: Natural history, physiology, and links with cardiovascular health. Climacteric, 2018; 21:96.
3.
LowDA, DavisSL, KellerDM, et al.Cutaneous and hemodynamic responses during hot flashes in symptomatic postmenopausal women. Menopause, 2008; 15:290.
4.
BaileyTG, CableNT, AzizN, et al.Exercise training reduces the acute physiological severity of post-menopausal hot flushes. J Physiol, 2016; 594:657.
5.
FisherWI, ThurstonRC. Measuring hot flash phenomenonology using ambulatory prospective digital diaries. Menopause, 2016; 23:1222–1227.
6.
KronenbergF. Hot flashes: Phenomenology, quality of life, and search for treatment options. Exp Gerontol, 1994; 29:319–336.
7.
GuthrieJR, DennersteinL, TaffeJR, et al.The menopausal transition: A 9-year prospective population-based study. The Melbourne Women's Midlife Health Project. Climacteric, 2004; 7:375–389.
8.
ThurstonRC, BrombergerJT, JoffeH, et al.Beyond frequency: Who is most bothered by vasomotor symptoms?. Menopause, 2008; 15:841.
9.
MitchellES, WoodsNF. Hot flash severity during the menopausal transition and early postmenopause: Looking beyond hormones. Climacteric, 2015; 18:536.
10.
Smith-DiJulioK, PercivalDB, WoodsNF, et al.Hot flash severity in hormone therapy users/nonusers across the menopausal transition. Maturitas, 2007; 58:191–200.
11.
RanceNE, DacksPA, Mittelman-SmithMA, et al.Modulation of body temperature and LH secretion by hypothalamic KNDy (kisspeptin, neurokinin B and dynorphin) neurons: A novel hypothesis on the mechanism of hot flushes. Front Neuroendocrinol, 2013; 34:211–227.
12.
ThurstonRC, JohnsonBD, ShufeltCL, et al.Menopausal symptoms and cardiovascular disease mortality in the Women's Ischemia Syndrome Evaluation (WISE). Menopause, 2017; 24:126.
13.
ThurstonRC, ChangY, Barinas-MitchellE, et al.Physiologically assessed hot flashes and endothelial function among midlife women. Menopause, 2017; 24:886–893.
14.
CrandallCJ, ZhengY, CrawfordSL, et al.Presence of vasomotor symptoms is associated with lower bone mineral density: A longitudinal analysis. Menopause, 2009; 16:239.
15.
GastGCM, GrobbeeDE, PopVJM, et al.Vasomotor symptoms are associated with a lower bone mineral density. Menopause, 2009; 16:231–238.
16.
CrandallCJ, AragakiA, CauleyJA, et al.Associations of menopausal vasomotor symptoms with fracture incidence. J Clin Endocrinol Metab, 2015; 100:524–534.
17.
DavidPS, SmithTL, NordhuesHC, et al.A clinical review on paroxetine and emerging therapies for the treatment of vasomotor symptoms. Int J Womens Health, 2022; 14:353.
18.
JohnsonKA, MartinN, NappiRE, et al.Efficacy and safety of fezolinetant in moderate to severe vasomotor symptoms associated with menopause: A Phase 3 RCT. J Clin Endocrinol Metab, 2023; 108:1981–1997.
19.
LedermanS, OtteryFD, CanoA, et al.Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): A phase 3 randomised controlled study. Lancet, 2023; 401:1091–1102.
20.
DailyJW, KoBS, RyukJ, et al.Equol decreases hot flashes in postmenopausal women: A systematic review and meta-analysis of randomized clinical trials. J Med Food, 2019; 22:127–139.
21.
AdolpheJL, WhitingSJ, JuurlinkBHJ, et al.Health effects with consumption of the flax lignan secoisolariciresinol diglucoside. Br J Nutr, 2010; 103:929–938.
22.
ColliMC, BrachtA, SoaresAA, et al.Evaluation of the efficacy of flaxseed meal and flaxseed extract in reducing menopausal symptoms. J Med Food, 2012; 15:840–845.
23.
SimbalistaRL, SauerbronnAV, AldrighiJM, et al.Consumption of a flaxseed-rich food is not more effective than a placebo in alleviating the climacteric symptoms of postmenopausal women. J Nutr, 2010; 140:293–297.
24.
PruthiS, QinR, TerstreipSA, et al.A phase III, randomized, placebo-controlled, double-blind trial of flaxseed for the treatment of hot flashes: North Central Cancer Treatment Group N08C7. Menopause, 2012; 19:48–53.
25.
DewTP, WilliamsonG. Controlled flax interventions for the improvement of menopausal symptoms and postmenopausal bone health: A systematic review. Menopause, 2013; 20:1207–1215.
26.
LandeteJM, ArquésJ, MedinaM, et al.Bioactivation of phytoestrogens: Intestinal bacteria and health. Crit Rev Food Sci Nutr, 2016; 56:1826–1843.
27.
ThompsonLU, ChenJM, LiT, et al.Dietary flaxseed alters tumor biological markers in postmenopausal breast cancer dietary flaxseed alters tumor biological markers in postmenopausal breast cancer. Clin Cancer Res, 2005; 11:3828–3835.
28.
McCannSE, EdgeSB, HicksDG, et al.A pilot study comparing the effect of flaxseed, aromatase inhibitor, and the combination on breast tumor biomarkers. Nutr Cancer, 2014; 66:566–575.
29.
Rodriguez-LeyvaD, WeighellW, EdelAL, et al.Potent antihypertensive action of dietary flaxseed in hypertensive patients. Hypertension, 2013; 62:1081–1089.
30.
BloedonLAT, BalikaiS, SzaparyPO, et al.Flaxseed and cardiovascular risk factors: Results from a double blind, randomized, controlled clinical trial. J Am Coll Nutr, 2008; 27:65–74.
31.
MessinaM. Soy and health update: Evaluation of the clinical and epidemiologic literature. Nutrients, 2016; 8:754.
32.
TakuK, MelbyMK, KronenbergF, et al.Extracted or synthesized soybean isoflavones reduce menopausal hot flash frequency and severity: Systematic review and meta-analysis of randomized controlled trials. Menopause, 2012; 19:776–790.
33.
LiL, LvY, XuL, et al.Quantitative efficacy of soy isoflavones on menopausal hot flashes. Br J Clin Pharmacol, 2015; 79:593.
34.
LiL, XuL, WuJ, et al.Comparative efficacy of nonhormonal drugs on menopausal hot flashes. Eur J Clin Pharmacol, 2016; 72:1051–1058.
35.
IinoC, ShimoyamaT, IinoK, et al.Daidzein intake is associated with equol producing status through an increase in the intestinal bacteria responsible for equol production. Nutrients, 2019; 11:433.
36.
FritzH, SeelyD, FlowerG, et al.Soy, red clover, and isoflavones and breast cancer: A systematic review. PLoS One, 2013; 8:e81968.
37.
PenottiM, FabioE, ModenaAB, et al.Effect of soy-derived isoflavones on hot flushes, endometrial thickness, and the pulsatility index of the uterine and cerebral arteries. Fertil Steril, 2003; 79:1112–1117.
38.
ColacurciN, De FranciscisP, AtlanteM, et al.Endometrial, breast and liver safety of soy isoflavones plus Lactobacillus sporogenes in post-menopausal women. Gynecol Endocrinol, 2013; 29:209–212.
39.
QuaasAM, KonoN, MackWJ, et al.Effect of isoflavone soy protein supplementation on endometrial thickness, hyperplasia, and endometrial cancer risk in postmenopausal women: A randomized controlled trial. Menopause, 2013; 20:840–844.
40.
AlekelDL, GenschelU, KoehlerKJ, et al.Soy Isoflavones for Reducing Bone Loss Study: Effects of a 3-year trial on hormones, adverse events, and endometrial thickness in postmenopausal women. Menopause, 2015; 22:185–197.
41.
MaskarinecG, TakataY, FrankeAA, et al.A 2-year soy intervention in premenopausal women does not change mammographic densities. J Nutr, 2004; 134:3089–3094.
42.
HooperL, MadhavanG, TiceJA, et al.Effects of isoflavones on breast density in pre- and post-menopausal women: A systematic review and meta-analysis of randomized controlled trials. Hum Reprod Update, 2010; 16:745–760.
43.
VerheusM, Van GilsCH, Kreijkamp-KaspersS, et al.Soy protein containing isoflavones and mammographic density in a randomized controlled trial in postmenopausal women. Cancer Epidemiol Biomarkers Prev, 2008; 17:2632–2638.
44.
MaskarinecG, VerheusM, SteinbergFM, et al.Various doses of soy isoflavones do not modify mammographic density in postmenopausal women. J Nutr, 2009; 139:981–986.
45.
MessinaBM, CaanBJ, AbramsDI, et al.Its time for clinicians to reconsider their proscription against the use of soyfoods by breast cancer patients. Oncology, 2013; 27:1–12.
46.
WilsonM, KondaV, HeidtK, et al.Rheum rhaponticum root extract improves vasomotor menopausal symptoms and estrogen-regulated targets in Ovariectomized Rat Model. Int J Mol Sci, 2021; 22:1–12.
47.
HegerM, VentskovskiyBM, BorzenkoI, et al.Efficacy and safety of a special extract of Rheum rhaponticum (ERr 731) in perimenopausal women with climacteric complaints: A 12-week randomized, double-blind, placebo-controlled trial. Menopause, 2006; 13:744–759.
48.
HasperI, VentskovskiyBM, RettenbergerR, et al.Long-term efficacy and safety of the special extract ERr 731 of Rheum rhaponticum in perimenopausal women with menopausal symptoms. Menopause, 2009; 16:117–131.
49.
Kaszkin-BettagM, VentskovskiyBM, SolskyyS, et al.Confirmation of the efficacy of ERr 731 in perimenopausal women with menopausal symptoms. Altern Ther Health Med, 2009; 15:24–34.
50.
JonesC, De VegaJ, LloydD, et al.Population structure and genetic diversity in red clover (Trifolium pratense L.) germplasm. Sci Rep, 2020; 10:1–12.
51.
TiceJA, EttingerB, EnsrudK, et al.Phytoestrogen supplements for the treatment of hot flashes: The Isoflavone Clover Extract (ICE) Study: A Randomized Controlled Trial. JAMA, 2003; 290:207–214.
52.
MyersSP, VigarV. Effects of a standardised extract of Trifolium pratense (Promensil) at a dosage of 80 mg in the treatment of menopausal hot flushes: A systematic review and meta-analysis. Phytomedicine, 2017; 24:141–147.
53.
KanadysW, BarańskaA, BłaszczukA, et al.Evaluation of clinical meaningfulness of red clover (Trifolium pratense L.) extract to relieve hot flushes and menopausal symptoms in peri- and post-menopausal women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 2021; 13:1258.
54.
GartoullaP, HanMM. Red clover extract for alleviating hot flushes in postmenopausal women: A meta-analysis. Maturitas, 2014; 79:58–64.
55.
GhazanfarpourM, SadeghiR, RoudsariRL, et al.Red clover for treatment of hot flashes and menopausal symptoms: A systematic review and meta-analysis. J Obstet Gynaecol, 2016; 36:301–311.
56.
AtkinsonC, WarrenRML, SalaE, et al.Red clover-derived isoflavones and mammographic breast density: A double-blind, randomized, placebo-controlled trial [ISRCTN42940165]. Breast Cancer Res, 2004; 6:R170.
57.
PowlesTJ, HowellA, EvansDG, et al.Red clover isoflavones are safe and well tolerated in women with a family history of breast cancer. Post Reprod Health, 2008; 14:6–12.
58.
BiliaAR, EternoF, VincieriFF. Black cohosh and climacteric symptoms: Growing knowledge about the efficacy and safety. Nat Prod Commun, 2007; 2:1043–1062.
59.
Anonymous. The use of black cohosh to treat symptoms of menopause. Fertil Steril, 2004; 81:27–34.
60.
Castelo-BrancoC, GambaccianiM, CanoA, et al.Review & meta-analysis: Isopropanolic black cohosh extract iCR for menopausal symptoms—An update on the evidence. Climacteric, 2021; 24:109–119.
61.
NuntanakornP. Black cohosh—A review. Silpakorn Univ Int J, 2004; 4:118–134.
62.
LeachMJ, MooreV. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database Syst Rev, 2012; 2012:CD007244.
63.
SadahiroR, MatsuokaLN, ZengBS, et al.Black cohosh extracts in women with menopausal symptoms: An updated pairwise meta-analysis. Menopause, 2023; 30:766–773.
64.
NaserB, SchnitkerJ, MinkinMJ, et al.Suspected black cohosh hepatotoxicity: No evidence by meta-analysis of randomized controlled clinical trials for isopropanolic black cohosh extract. Menopause, 2011; 18:366–375.
65.
LundströmE, HirschbergAL, SöderqvistG. Digitized assessment of mammographic breast density—Effects of continuous combined hormone therapy, tibolone and black cohosh compared to placebo. Maturitas, 2011; 70:361–364.
66.
HirschbergAL, EdlundM, SvaneG, et al.An isopropanolic extract of black cohosh does not increase mammographic breast density or breast cell proliferation in postmenopausal women. Menopause, 2007; 14:89–96.
67.
Hernández MuñozG, PluchinoS. Cimicifuga racemosa for the treatment of hot flushes in women surviving breast cancer. Maturitas, 2003; 44:S59–S65.
68.
PockajBA, GallagherJG, LoprinziCL, et al.Phase III double-blind, randomized, placebo-controlled crossover trial of black cohosh in the management of hot flashes: NCCTG Trial N01CC1. J Clin Oncol, 2006; 24:2836–2841.
69.
PockajBA, LoprinziCL, SloanJA, et al.Pilot evaluation of black cohosh for the treatment of hot flashes in women. Cancer Invest, 2004; 22:515–521.
70.
WangC, HuangQ, LiangCL, et al.Effect of cimicifuga racemosa on menopausal syndrome caused by LHRH-a in breast cancer. J Ethnopharmacol, 2019; 238:111840.
71.
JacobsonJS, TroxelAB, EvansJ, et al.Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol, 2001; 19:2739–2745.
72.
RostockM, FischerJ, MummA, et al.Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints—A prospective observational study. Gynecol Endocrinol, 2011; 27:844–848.
73.
BairYA, GoldEB, ZhangG, et al.Use of complementary and alternative medicine during the menopause transition: Longitudinal results from the Study of Women's Health Across the Nation. Menopause, 2008; 15:32–43.
74.
BrettKM, KeenanNL. Complementary and alternative medicine use among midlife women for reasons including menopause in the United States: 2002. Menopause, 2007; 14:300–307.
