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Breast Cancer Survivors Finally Have Weapon Against Menopause

WebMD Health News

Oct. 4, 2001 -- Fifteen years ago, June Adler, then 44, underwent chemotherapy, radiation therapy, and lumpectomy in her battle against breast cancer. She was prepared for the side effects of treatment, but not for the hot flashes and other symptoms she experienced as a result of early menopause caused by her treatment.

"The hot flashes certainly weren't the worst thing I had to deal with at the time, but they were annoying," the Chicago resident tells WebMD. "I guess at their worst I had four or five a day. I tried one old-time remedy that was being taken at the time, but nothing helped."

The most popular treatment for symptoms of menopause, hormone replacement therapy, was not a good option because it is not recommended for women who have had breast cancer due to the fear that it might cause the cancer to come back.

So when Adler was treated there were few, if any, safe and effective therapies available to relieve the symptoms of menopause in women with a history of breast cancer. And even today many highly publicized remedies like soy and vitamin E have proven disappointing in clinical studies.

But researchers may have finally found an effective and safe option for treating hot flashes and other menopausal symptoms in women who have had breast cancer. Studies from Rochester, Minnesota's Mayo Clinic showed that breast cancer survivors treated with the antidepressant Effexor had a 60% reduction in hot flashes. The widely prescribed antidepressants Prozac and Paxil also appear to be effective, researcher Charles L. Loprinzi, MD, tells WebMD.

"To date, these new antidepressants are the best of the non-hormonal treatments we have looked at for hot flashes," Loprinzi says. "These findings have implications for breast cancer survivors and for other survivors of [hormone-dependent] cancers, such as men who have been treated for prostate cancer."

Loprinzi was scheduled to present an update on menopause treatment options in women with a history of breast cancer on Oct. 6 at the 12th Annual Meeting of The North American Menopause Society in New Orleans.

The average age of menopause for women in the U.S. is 51, but those who have been treated for breast cancer commonly experience early menopause as a side effect of chemotherapy. It is estimated that nearly half of women under the age of 40 and more than three-quarters of older women who undergo chemotherapy for breast cancer become menopausal as a result of treatment.

Although several recent studies suggest that hormone replacement therapy does not promote cancer recurrence, few doctors are willing to prescribe it for their breast cancer patients and few women are willing to take it, Loprinzi says.

"These studies are compelling, but they are not definitive," he says. "And right now it would be a hard sell to physicians and patients. They want a nonestrogen alternative."

The Mayo researcher and his colleagues have been trying to find such an alternative for more than a decade. He says their studies have suggested that vitamin E and soy are no more effective than treatment with placebo for reducing hot flashes. The blood pressure medication clonidine proved to be somewhat more effective than placebo treatment, but caused unacceptable side effects of its own, such as drowsiness and constipation.

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