Hot flashes can greatly diminish a woman’s quality of life, disrupting sleep at night or causing embarrassment from heat, sweat and reddened upper body as she goes about her daily business.
In women with a history of breast cancer, hot flashes, called flushes in medical circles, are common due to taking tamoxifen and aromatase; chemotherapy and from menopause.
A new Cochrane review finds that a variety of non-hormonal treatments (mostly non-hormonal drugs) can offer women who have had breast cancer some relief from hot flashes, but could not determine if one was better than the other. Side effects are frequent, however, and must weigh into any decisions to use the interventions.
Researchers in Chile analyzed 16 studies including 1,461 women and found that several different non-hormonal drugs and one non-drug treatment – relaxation therapy – might help relieve symptoms.
Non-hormonal therapies – medications and complementary type interventions do not appear to alter a woman’s hormonal state. For this reason, several “holistic” remedies such as black cohosh and phytoestrogens do not qualify as non-hormonal because they might alter a woman’s hormonal balance. “None are clearly superior,” said lead author Gabriel Rada, M.D., director of the Evidence Based Medicine Unit at Catholic University of Chile.
“We found that relaxation therapy, the antihypertensive clonidine, the anticonvulsant gabapentin, and some antidepressants that inhibit serotonin reuptake, have a mild to moderate effect,” lead author Gabriel Rada, M.D., director of the Evidence-Based Medicine Unit at the Catholic University of Chile. “Our review is not able to say which alternative is superior, and some of them have adverse effects, so the choice must be made on an individual patient basis.”
Pharmacological agents included vitamin E, clonidine (a blood pressure medicine), gabapentin (a seizure medicine) and various antidepressants.
“The beneficial effects they found with the medications, with regard to the number, frequency or severity of the flushes, were statistically significant, but it’s not clear that those effects were clinically significant,” said Susan M. Cohen, Ph.D., an associate professor at the University of Pittsburgh School of Nursing. “And you have to ask if the side effects were worth those benefits.”
For example, she said, anti-seizure medication might force a woman to give up driving. Cohen pointed out that clonidine lowers blood pressure even in women who do not have high blood pressure and its possible side effects include dizziness, dry mouth, constipation and a skin reaction.
Non-drug interventions were magnetic therapies (devices placed on patients’ skin), relaxation therapies (various stress management techniques), acupuncture and homeopathy.