Hot flashes are annoying and uncomfortable, especially when they strike at inopportune moments—for instance in the middle of a job interview, black-tie event or chance encounter with an old flame. Equally annoying are night sweats, those episodes of overheating that wake women from slumber, making it impossible to sleep soundly.

About 75% of menopausal women experience these sudden rushes of heat that can leave them dripping with perspiration (so if you are approaching midlife and it hasn’t happened to you yet, chances are that it will someday). No wonder they often feel desperate for relief! Yet many are understandably reluctant to resort to the conventional treatment, hormone therapy, because it can increase the risk for heart disease, stroke, blood clots and breast cancer.

So here are some alternative therapies that have credible scientific evidence for being safe and effective at reducing hot flashes from Julia Schlam Edelman, MD, a gynecologist and certified menopause clinician and author of Menopause Matters: Your Guide to a Long and Healthy Life. Dr. Edelman said that for certain women whose menopausal symptoms are debilitating and whose risk for cardiovascular problems and breast cancer is low, the benefits of hormone therapy may outweigh the risks—but even so, it just makes sense to try safer alternatives first. Here’s what really works…

BODY-COOLING BREATHING TECHNIQUE

It sounds almost too good to be true (and experts aren’t sure how it works), but paced respiration—a form of very slow, deep breathing—has been found to decrease the frequency and severity of hot flashes by up to 80%, Dr. Edelman said. To teach yourself paced respiration, sit comfortably in a quiet place where you won’t be interrupted. Slowly inhale for five seconds (counting to yourself, “one, one thousand… two, one thousand” etc.). Don’t hold your breath after inhaling—instead, exhale in the same slow manner for five seconds (silently counting backward, “five, one thousand… four, one thousand” etc.). The goal is to take five to seven breaths per minute rather than the typical 12 breaths.

Practice twice a day until you can comfortably perform the technique continuously for 15 minutes, Dr. Edelman suggested—this trains your body to breathe slowly on command. Then, to reduce hot flash frequency, do paced respiration for five to 15 minutes each morning and evening. Also do the technique whenever you experience a hot flash or awaken from a night sweat—this makes symptoms subside more quickly. Bonus: Paced respiration also reduces blood pressure.

NUTRITIONAL HEAT-SOOTHERS

Various studies indicate that certain dietary approaches can help reduce hot flashes. What works best…

Flaxseed. In a small study from Mayo Clinic, women who had at least 14 hot flashes weekly added four tablespoons of crushed flaxseed per day to their diets. After six weeks, they reported that their hot flashes had decreased in frequency by half and in severity by 57%, on average. Theory: Flaxseed contains lignans, antioxidants that may have estrogenic effects. More research is needed, Dr. Edelman noted, but in the meantime, flaxseed looks promising—plus it contains heart-healthy omega-3 fatty acids.

Try it: Add crushed flaxseed to cereal, juice, yogurt or fruit dishes. To avoid constipation (or even intestinal blockage), be sure to drink plenty of water at the same time. Caution: Do not consume flaxseed within two hours of taking oral medication—flaxseed may interfere with medication absorption.

Fiber. Research suggests that women whose daily diet includes at least 30 grams of fiber have fewer hot flashes than women who consume less fiber. The research is on fiber from foods rather than supplements, Dr. Edelman pointed out, so to boost your fiber intake, eat more fruits, vegetables, brown rice and whole grains.

Vitamin E. Though studies have had mixed results, some research indicates that vitamin E does help ease hot flashes. Taking up to 400 international units (IU) daily is safe for most women, Dr. Edelman said, though as with any nutritional supplement, check with your doctor before beginning. Caution: To avoid bleeding problems, do not take vitamin E if you take blood-thinning medication, such as aspirin or warfarin (Coumadin), or an anti-inflammatory drug, such as ibuprofen (Motrin) or naproxen (Aleve)… if you supplement with evening primrose oil, ginkgo biloba, garlic or ginger… or if you have ulcers or heavy periods.

Cutting back on caffeine. While any hot liquid can trigger hot flashes, caffeinated coffee is a particular problem because it disrupts sleep and promotes night sweats. Simply avoiding caffeine in the evening isn’t enough—because six hours after you ingest caffeine, half of it still remains in your system. “This means that if you drink a medium cup of coffee containing 200 mg of caffeine at 4 pm, 100 mg of caffeine will still be left in your body at 10 pm,” Dr. Edelman said. Tea has less caffeine than coffee but still may cause problems if you are sensitive to caffeine.

Abruptly eliminating caffeine can bring on severe headaches, so instead, cut back on your caffeinated beverage intake by two ounces for seven days… then cut back by another two ounces for seven more days. If your hot flashes disappear, you can continue drinking that amount… otherwise, keep reducing by two ounces per week. Does it really work? It’s worth a try. Dr. Edelman said, “I’ve had patients who completely got rid of their hot flashes this way.”