June 12, 2000 -- Either before or during menopause, three of every four women will experience hot flashes -- the sudden bursts of skin-searing heat that can quickly leave the sufferer glistening with sweat. But no one knows what causes this alarming symptom.
The best known treatment for hot flashes is estrogen, but many women are afraid to take the hormone for fear that it may increase their risk of breast cancer. Women's health experts have long been eager to find an alternative, and now a new report suggests that a drug used to treat epilepsy may be the best option.
Neurologist Thomas J. Guttoso Jr., MD, noticed that a woman who was taking the drug for treatment of migraine headaches reported that after just two days on the drug "her hot flashes were gone," he tells WebMD, adding that it didn't help her migraines.
The drug is called gabapentin and, in addition to its FDA-approved use to control seizures associated with epilepsy, it is now used to treat bipolar disorder as well as some social phobia disorders, he says.
Published side effects of the drug include convulsions that occur after suddenly stopping the drug, hypertension, fatigue, dizziness, and a variety of other symptoms. The way in which the drug works is unknown, according to the authors, and they note the need for further studies to determine how it works and whether it can be used to treat hot flashes.
There have been other drugs that work on the brain and central nervous system that appear to reduce hot flashes, but more research is needed before they can be approved or prescribed for that use. It is important that you only take medication prescribed for you and for your specific conditions.
Guttoso, who is an instructor of neurology at the University of Rochester School of Medicine, says he thinks the drug affects an area of the brain called the hypothalamus, which he thinks has a role in regulating the body's temperature. Specifically, he suggests the drug works on the levels of substances called tachykinins, which regulate the contraction and dilation of smooth muscles. The drug appears to affect the flow of these tachykinins, he says.
He describes his theory and the effect of gabapentin on a handful of patients in the June 13 issue of the journal Neurology. Guttoso says that the drug "reduced the frequency of hot flashes by about 87%" in the six patients he describes in the article. A seventh patient who suffered from hypothermia -- a condition of low body temperature -- had a 100-fold increase in these episodes, with temperatures as low as 95? F.
He is so impressed by these early results that he says he will study the drug by measuring blood levels of tachykinins in women taking it to see if their levels decrease. "If the levels drop, that would support my theory," says Guttoso.
Although most of the patients in whom he tried the drug for hot flash relief are women, the drug also worked for a man taking hormone treatment for prostate cancer. He experienced about 15 hot flashes a day, most of them at night, says Guttoso. Taking gabapentin before bed "completely eliminated the nighttime hot flashes," he says.
Currently, the most effective treatment for hot flashes is hormone therapy, but "women with present cancers or with a family history of breast cancer want to avoid hormones," says Margery Gass, MD, director of the menopause and osteoporosis center at the University of Cincinnati Medical Center and associate professor of obstetrics and gynecology at University of Cincinnati School of Medicine.
"There is a great interest in and a great need for nonhormonal approaches to treating hot flashes," Gass tells WebMD. She says she welcomes Guttoso's efforts and looks forward to the results of his new study, which he says he hopes to have ready for publication in a year.
For more information from WebMD, go to our Diseases and Conditions Menopause