Regular exercise may reduce vasomotor symptoms of menopause (strength of recommendation [SOR]: C--single observational study). Soy products/isoflavones, either through diet or supplementation, may reduce the incidence of hot flushes (SOR: D--inconsistent results of randomized trials). Clonidine, as an oral or transdermal preparation, reduces hot flushes (SOR: A--randomized clinical trials), as does gabapentin (SOR: A-- single randomized clinical trial). In cancer patients who have had surgical menopause, selective serotonin reuptake inhibitors and megestrol (Megase) have been effective in reducing hot flushes (SOR: A; B for extrapolation to the general population). Other therapies--including Bellergal (a combination of belladonna, ergotamine, and phenobarbital), methyldopa, evening primrose oil, maiquan, flaxseed, ginseng, and topical wild yam extract--have not been effective. Black cohosh may be effective, but the evidence for this is of poor quality (SOR: C)
