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Non-Hormonal Options for Hot Flashes Have Drawbacks

Side effects, costs and poor efficacy compared to estrogen make them suboptimal choices for most women

TUESDAY, May 2 (HealthDay News) -- Non-hormonal therapies for menopausal hot flashes appear to show some efficacy, but are not as effective as estrogen and have other drawbacks, according to a meta-analysis of 43 trials published in the May 3 issue of the Journal of the American Medical Association.

Heidi D. Nelson, M.D., M.P.H., of the Oregon Health and Science University in Portland, and colleagues selected 43 randomized, double-blind, placebo-controlled trials from 4,249 abstracts. Ten of the trials tested antidepressants to relieve hot flashes, 10 tested clonidine, six tested other prescription drugs and 17 tested isoflavone extracts.

The studies suggested that selective serotonin-reuptake inhibitors, such as paroxetine, or other drugs, such as clonidine or gabapentin, have some efficacy compared with placebo, but they were less efficacious than estrogen. "These therapies may be most useful for highly symptomatic women who cannot take estrogen but are not optimal choices for most women," the authors write.

Women with mild hot flashes may require no treatment at all, and physicians should understand the risks and benefits of hormonal and non-hormonal therapies for those with disruptive hot flashes, according to an editorial. "Hormone therapy is more effective than non-hormonal alternatives but should probably be avoided by women at high risk for venous thromboembolic events, cardiovascular disease and breast cancer," the editorial concludes.

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