Q: Can you suggest a product for hot flashes?

You say you’d been using Relizen, but tried another over-the-counter product that didn’t work as well. When you went back to Relizen, it wasn’t as effective. Relizen is actually my first recommendation for non-hormonal hot flash management; patients in my practice have had great success. I have had nearly no success with Amberen, the other product you tried. I’m not sure why Relizen wouldn’t work now when it previously had. Have you been on it for 12 weeks or longer? Sometimes it can take that long to have benefit.

There are dozens and dozens of herbal products that claim hot flash relief; virtually none of them have clinical data to support claims of benefit. I am not opposed to women using herbal products, they just can’t be depended upon to work very well. The most widely used non-hormonal treatment of hot flashes is Effexor (venlafaxine), a prescription antidepressant that for about half of women reduces hot flashes—but is has its own side-effect profile that needs to be considered. Talk to your health care provider about that as an option. Prozac, Lexapro and Paxil also may provide some benefit. I have had patients who have had quite good success with acupuncture as well.

Of course the most effective treatment of hot flashes is estrogen. And there is exciting research for non-estrogen options in treating hot flashes. They influence temperature regulation in the brain, but those are likely a few years before coming to market.