Gynecologic Health

Beating the Heat: New Treatments for Hot Flashes

Women who have a history of breast cancer or are at high risk for developing the disease are not good candidates for estrogen replacement. Are there any other hormonal treatments these women can use to ease their hot flashes?
We've had good results with megestrol acetate (Megace), a hormone that stimulates appetite at high doses, but at very low doses it decreases hot flashes by 85% compared to a 25% reduction with placebo. In fact, megestrol acetate seems to work as well as estrogen. However, it's still a hormone, and there are lingering concerns about giving any hormone to breast cancer patients.

What non-hormonal treatments are researchers looking at? How do they stack up?
We've looked at clonidine (Catapres), a blood pressure medication that decreases hot flashes by about one hot flash per person per day, which isn't much but it's more than a placebo. But clonidine has its own set of side effects, such as drowsiness, dry mouth, sleep problems and light-headedness, plus it's not especially effective.

We've also looked at vitamin E, which, like clonidine, decreases hot flashes by about one hot flash per person per day. The nice thing about vitamin E is that it's cheap. It's readily available. It's nontoxic. But it's not good enough. Hot flashes haven't gone away despite the widespread use of vitamin E.

Some doctors have started prescribing antidepressants for hot-flash relief. What is the research telling us about these medications as a weapon against hot flashes?
We conducted a placebo-controlled, double-blinded trial that studied the effects of three different doses of the antidepressant venlafaxine (Effexor). The lowest dose was 37.5 mg a day, the next highest was 75 mg and the highest was 150 mg a day. Here's the bottom line: The placebo reduced hot flashes by about 27% over a four-week period. The 37.5 mg dose of venlafaxine decreased them by about 40%. And the two higher doses reduced them equally by about 60%.

We also looked at fluoxetine (Prozac), another antidepressant, and found that it significantly decreased hot flashes, too - not quite as much as venlafaxine, but the important thing we found out was that more than one antidepressant can be effective. Paroxetine (Paxil), too, seems to cut hot flashes by about 60%. Gabapentin (Neurontin), a member of a newer class of medications used to treat nerve-based pain and seizures, has also been shown to decrease hot flashes by about 50%.

Are these treatments as effective in women with breast cancer-related hot flashes as they are in healthy menopausal women?
A hot flash is a hot flash. What works for hot flashes works whether they were caused by tamoxifen or natural menopause.

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