Dr Bollmann, Skin Care Expert, Anti-Aging Specialist

As a gynecologist with many years experience and a special interest in hormonal replacement in the menopause, I have seen many women waste money on non-prescription "hormonal" supplements to relieve hot flashes and other symptoms.

First, it is not hormonal if not a prescription - the FDA does not allow that. As the owner of Bare Skin Care, I was excited to learn that estrogen was the second best thing to correct wrinkles (second to Retin-A or other retinoids), but then deflated when I asked my chemist to add it to Bare Skin Care, and was told that could not be done because of the FDA.

So I said, "Well, what about all the progesterone products out there advertised to relieve all kinds of symptoms." And he said, "Simple, they don't contain progesterone."

A recent study in Women's Health found that 50% to 80% of menopausal women turn to non-hormonal therapies to try and gain some relief from hot flashes, though many non-hormonal treatments are ineffective, meaning that women keep on suffering until they finally find a treatment that works.

Well, we know bio-identical hormone replacement works, using the same hormones found in the body. And in my opinion, relief from hot flashes is not the main reason to take hormones. The main effect, again in my opinion, is protection of the brain - the only debate about hormonal replacement and Alzheimer's disease is whether it prevents it 70% or 90%. And it effects other body organs as well, including the vaginal tissues, making sexual activity more pleasurable.

But not everyone can take HRT, for various reasons. You should ask your doctor about this if he/she says you can't take them. However, as a caveat, many physicians say you don't need them. If you have one of these doctors, my advice is simple - find someone who know what they are doing and find a doctor who believes in HRT.

If you are unable to take them, results of a recent review have shown that there are several non-hormonal treatments that can successfully dampen hot flashes. Research has shown that a cognitive-behavioral therapy approach, which combined relaxation techniques, sleep hygiene, and learning to take a positive approach to menopause challenges, was effective at reducing women's ratings of hot flash problems (although it did not reduce the number of hot flashes). Another treatment, proven to help women in randomized, controlled trials, is clinical hypnosis. Various non-hormonal prescription medications can be of help, although these may not offer as much relief as hormones. Selective serotonin re-uptake inhibitors (SSRIs), including paroxetine, are the only FDA-approved non-hormonal therapy for hot flashes, and they can offer mild to moderate improvements. Other medications shown to be helpful include serotonin-norepinephrine reuptake inhibitors (SNRIs), the gabapentinoids, and clonidine. Other treatments that may help include weight loss, stress reduction, a soy derivative (S-equol), and a type of nerve block called stellate ganglion block, although the evidence that these treatments are effective isn’t as strong. There is no evidence to support theories that exercise, yoga, paced respiration, and acupuncture work for hot flashes, however these approaches do offer other health benefits.