A total of 29 RCTs were included.
Herbal remedies (10 RCTs, n=962).
The majority of the studies reported no significant changes in the primary outcome measures. Only black cohosh showed a beneficial effect. The authors state that questions remain about the long-term safety of most herbs.
Dietary phytoestrogens (11 RCTs, n=1,230).
The authors report that comparisons were difficult because of variations in product, dosage, scoring systems for symptoms of hot flashes, and the menopausal status of the patients. Three of the 8 studies with treatment phases lasting longer than 6 weeks showed significant improvement in hot flashes. In general, the data showed only modest benefits, which mostly disappeared after 6 weeks.
Other CAM therapies.
Vitamin E: 2 RCTs, conducted in 1953 (n=658) and 1998 (n=125), respectively, reported that vitamin E was no more effective then placebo.
Acupuncture: one study (n=24) that compared electroacupuncture to a shallow acupuncture control group reported no differences between the groups.
Behavioural therapies: 3 studies investigated therapies including paced respiration or biofeedback control (n=57), and a relaxation response technique (n=45). On the whole, intervention groups experienced a significant decrease in hot flashes compared with the control. The authors state that behavioural therapies seem to be safe.
Wild yam and progesterone creams: one study (n=23) that compared wild yam cream with placebo reported no significant difference on any outcome. A second study (n=102) investigated the effects of progesterone cream on hot flashes as a secondary outcome. Compared with placebo, patients in the intervention group reported a significant 'improvement'. Eight women treated with progesterone cream experienced vaginal spotting.