Non-Hormone Therapies Offer Some Hot-Flash Relief

But they're not as effective as estrogen therapy for menopausal women, study finds

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By Kathleen Doheny
HealthDay Reporter

TUESDAY, May 2, 2006 (HealthDay News) -- Using non-hormone treatments, such as antidepressants and blood pressure medicine, for menopause-related hot flashes provides some relief. But they aren't as effective as estrogen therapy, a new study found.

And, like hormone replacement therapy, some non-hormone treatments may have adverse effects, making it best to limit their use, the researchers said.

"For women who have mild to minimal symptoms, it would be better to not take anything," said study lead author Dr. Heidi D. Nelson, of Oregon Health & Science University in Portland.

The findings appear in the May 3 issue of the Journal of the American Medical Association.

Interest in non-hormone treatments for menopause symptoms has grown in the wake of the Women's Health Initiative study, which was halted three years ahead of schedule, in 2002, when researchers found a higher risk of breast cancer, blood clots, stroke and heart attack in women on hormone therapy.

For the new research, Nelson and her colleagues did a so-called meta-analysis, pooling and then analyzing the results of 43 clinical trials on non-hormone remedies. They looked at the effectiveness of each treatment for hot flashes, a common menopausal symptom.

"We focused on hot flashes, which can be counted," said Nelson.

What helped? Antidepressants; the blood pressure medicine clonidine (Catapres); and gabapentin (Neurontin), a seizure medication, all reduced -- to some extent -- the frequency and severity of hot flashes. Red clover isoflavone extracts didn't make a difference. And results of the studies on soy isoflavones, another popular remedy, were mixed.

The non-hormone treatments didn't provide complete relief, however.

"Clonidine reduced hot flashes by about one a day," Nelson said. The SSRI type of antidepressant, such as paroxetine (Paxil), also reduced hot flashes by about one a day. And gabapentin reduced them by about two a day, she said.

With hormone replacement therapy, there was an average reduction of two-and-a-half to three hot flashes a day, Nelson said. Whether that reduction is worth it depends on how many hot flashes a woman has in a typical day, she said.

Many doctors suggest that women with symptoms severe enough to disturb their life can take the lowest effective dose of hormone replacement therapy for the shortest period of time possible.

In an accompanying editorial in the journal, Dr. Jeffrey Tice, an assistant professor of medicine at the University of California, San Francisco School of Medicine, noted that all non-hormonal treatments have side effects. For instance, the antidepressant Paxil can cause headache, insomnia, anxiety and sexual dysfunction. And, he added, in the trials reviewed for the meta-analysis, the treatments were only studied for a few months, so there's no long-term research on their use for hot flash relief.

"All antidepressants aren't created equal," he said. "The one antidepressant with the most consistent evidence [for hot flash relief] is Paxil."

For some women with milder menopausal symptoms, it may be enough to avoid triggers of hot flashes, such as spicy foods, and to drink cool drinks when a flash occurs, Tice said. "Start with that. If you don't need drugs, don't take them," he said.

Nelson also suggested other measures, such as layering clothes and removing them when hot flashes strike.

"Women with disturbing symptoms, if they are not eligible for estrogen, they should look at these other therapies and perhaps find some relief," she said.

More information

To learn more about menopause, visit the North American Menopause Society.

SOURCES: Heidi D. Nelson, M.D., M.P.H., professor of medicine and medical informatics and clinical epidemiology, Oregon Health & Science University and Providence Health System, Portland; Jeffrey A. Tice, M.D., assistant professor of medicine, University of California, San Francisco School of Medicine; May 3, 2006, Journal of the American Medical Association

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