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    Posted: 05/10/2006
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Nonhormonal Therapies Have Little Effect on Hot Flashes

Reprinted from the NCI Cancer Bulletin, vol. 3/no. 19, May 9, 2006 (see the current issue).

Hot flashes occur in half of all women undergoing menopause, and also are associated with cancer treatments such as tamoxifen and oophorectomy. Estrogen and other hormone treatments were widely used until 2002 when two large trials showed a small increased risk of blood clotting, stroke, coronary events, and cancer. Thus, information about nonhormonal treatment is of interest to cancer patients and researchers.

A review and meta-analysis of all such trials appeared in the May 3, 2006, Journal of the American Medical Association. Dr. Heidi D. Nelson and colleagues of the Oregon Health & Science University identified 4,249 potentially relevant trials published in English and selected 24 for meta-analysis (see the journal abstract).

Trials with antidepressants (primarily selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors) reduced by 1.13 the number of daily hot flashes compared with placebo. Trials with the high blood pressure drug, clonidine, showed 0.95 fewer hot flashes per day. Trials with gabapentin, an anticonvulsant, resulted in 2.05 fewer hot flashes per day. No reduction was seen with soy isoflavone extracts and results were inconclusive with red clover isoflavone extracts.

"Overall, the effect of these agents on hot flashes is modest, and they all have side effects," said Dr. Jennifer Eng-Wong of the Medical Oncology Branch in NCI's Center for Cancer Research (CCR).

In an editorial, Drs. Jeffrey Tice and Deborah Grady of the University of California, San Francisco noted that "Hormone therapy is more effective than nonhormonal alternatives but should probably be avoided by women at high risk for venous thromboembolic events, cardiovascular disease, and breast cancer."

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