Treating Breast Cancer’s Hot Flashes
by Charles L. Loprinzi, MD
Hot flashes are a major problem for many women as they go through the menopausal transition and, for some, for many years thereafter. They are a bigger problem for women with a history of breast cancer, mainly because some of the treatments for breast cancer cause hot flashes and because women with breast cancer are advised to avoid estrogen, a common hot flash treatment.
While estrogen, or a combination of estrogen and progesterone, agents have been proven to reduce hot flashes, they are commonly avoided in women with breast cancer because they are associated with an increased breast cancer risk. Because of this, many clinical trials have evaluated non-hormonal agents as a means of decreasing hot flashes. Many of these trials have reported positive results. One of the older of these agents is clonidine, a drug used to treat to high blood pressure. This drug decreases hot flashes about 15 to 20 percent more than does placebo, which tends to decrease hot flashes by about 25 percent. Clonidine is moderately well tolerated but can cause dry mouth, drowsiness, and constipation.
Many clinical trials have evaluated non-hormonal agents as a means of decreasing hot flashes.
Several antidepressant drugs decrease hot flashes more than is usually seen with clonidine. These drugs include venlafaxine, paroxetine, desvenlafaxine, and citalopram, all of which appear to decrease hot flashes by about 50 percent. However, the antidepressants fluoxetine and sertraline do not seem to decrease hot flashes as well.
Gabapentin and pregabalin are drugs that were initially developed for the treatment of seizures but are more commonly used for treatment of pain. Both of these drugs appear to decrease hot flashes to a similar degree as the newer antidepressants.
A variety of other drugs and procedures have been investigated as potential hot flash therapies. The vast majority of studies looking at soy products and the herb black cohosh have reported that they are no more effective than a placebo. Similarly, most acupuncture trials have not demonstrated any benefit over that seen with a placebo procedure. Ongoing studies are evaluating exercise, yoga, relaxation training, and hypnosis. At this time, however, none of these can be strongly recommended.
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Dr. Charles Loprinzi is the Regis Professor of Breast Cancer Research at the Mayo Clinic in Rochester, MN.
This article was originally published in Coping® with Cancer magazine, July/August 2012.