Treating Hot Flashes Without Hormones
Review Shows Estrogen May Work Better Than Nonhormonal Therapies
May 2, 2006 -- Some nonhormonal therapies may help treat hot
flashes, but probably not as much as estrogen, doctors report in
The Journal of the American Medical Association.
Those findings come from a review of 43 previously published studies. The
reviewers included Heidi Nelson, MD, MPH, of Oregon Health & Science
disease. But hot flashes are common and may be severe in menopausal women.
The studies in Nelson's review tested these therapies to treat hot
Antidepressants. Selective serotonin reuptake inhibitors
(SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) such as Paxil,
Prozac, Effexor, and Celexa
Clonidine (Catapres). A blood pressure medication made in
pill or patch form
Gabapentin (Neurontin). An antiseizure medication
Red clover isoflavone extracts
Soy isoflavone extracts
Each treatment was separately compared with a sham treatment (placebo). The
women didn't know whether they received the real treatment or placebo. They
kept diaries of their hot flashes before and during treatment, which ranged in
length from a few weeks to a year.
Interest Beyond Estrogen
Estrogen has long been used to treat menopausal symptoms.
"However, recent studies reporting adverse effects of estrogen, such as
cardiovascular events and breast cancer,
raise important concerns about its use," write Nelson and colleagues. Those
concerns have spurred interest in alternative treatments for menopausal
Estrogen may still be used to treat menopausal symptoms. The FDA advises
doctors to prescribe "the smallest effective dose for the shortest duration
possible," write Nelson and colleagues.
Nelson's study uses the term "nonhormonal therapies" for treatments
that weren't based on the hormones estrogen, progestin, progesterone, or
Isoflavones (natural chemicals in some plants, including soy), may have
estrogen-like effects. For simplicity's sake, the reviewers considered
isoflavone extracts to be nonhormonal therapies.
The SSRIs, SNRIs, Catapres, and Neurontin studies showed evidence of
effectiveness, Nelson's team writes.
However, they were less effective than estrogen. Also, there are few
published studies, and most of the studies had design weaknesses, they
Side effects and cost may restrict use for many women, they write. Side
effects included nausea, headache, dry mouth, and decreased appetite.
"These therapies may be most useful for highly symptomatic women who
cannot take estrogen but are not optimal choices for most women," write
Nelson and colleagues.
The researchers found no sign that red clover isoflavone extracts reduced
flashes. The results on soy isoflavone extract studies were
As Nelson's team noted, some studies were higher in quality than others.
Also, some trials included women who had had breast cancer and
were taking tamoxifen; those women may not represent other menopausal women.
Hot flashes are a common side effect of tamoxifen use. Those limits may make it
hard to draw definite conclusions.