Relieving Hot Flashes
Now, this is a hot topic (sorry, could not resist that one) for many of us. Chemotherapy puts many women into instant menopause (likely to happen to women in their 40s or older who are still having their periods). The hormonal/anti-estrogen treatments cause hot flashes for almost everyone, even for women who have already been through menopause and did not anticipate the opportunity to relive that experience. There is enormous variability in their intensity. I was fortunate to only have "warm flashes", but I have known many women who were miserable from intense hot flashes that make them red in the face and cover them with sweat. We all learn what our own triggers might be (stress, hot spicey food, caffeine, red wine), but often the flashes just come. Hot flashes at night that disrupt sleep are especially distressing.
There ae a range of possible treatments, but none are fully successful for all women all the time. More often, a particular medication helps for a while, and then is less effective. The guru on this topic is Dr Charles Loprinzi at the Mayo Clinic; you can Google him to see some of his articles.
This is a summary from Journal Watch:
Relieving Hot Flashes in Breast Cancer Survivors
Venlafaxine and clonidine were statistically superior to placebo.
One of the most common complaints from breast cancer survivors is bothersome hot flashes caused by many adjuvant therapies. Accordingly, many strategies (both hormonal and nonhormonal) have been tested for efficacy in attenuating hot flash frequency and severity: Agents including antidepressants, anticonvulsants, antihypertensives, and progestins have been evaluated with varying results (JW Womens Health Feb 26 2009 (Link to: http://womens-health.jwatch.org/cgi/content/full/2009/226/1) ). However, few studies have used validated assessment tools and sufficient numbers of participants to arrive at clinically useful conclusions.
Dutch investigators conducted a randomized, double-blind, placebo-controlled trial in 102 patients with histories of breast cancer who had natural menopause, chemotherapy-induced menopause, or suppressed ovarian function and who experienced 2 hot flashes per day. Participants received daily venlafaxine (75 mg), clonidine hydrochloride (0.1 mg), or placebo for 12 weeks and used validated diaries to report hot flashes; daily hot flash scores (calculated based on both severity and frequency) were assessed during week 12. Women also completed questionnaires at baseline and during treatment about sexual function, sleep quality, anxiety, and depression.
At 12 weeks, venlafaxine and clonidine were statistically superior to placebo for lowering hot flash scores from baseline. Although the efficacy of both agents was similar at 12 weeks, venlafaxine lowered hot flash scores more rapidly than did clonidine. Nausea, constipation, and appetite loss were more common with venlafaxine than with clonidine.
Comment: These data indicate that either venlafaxine or clonidine could be used to relieve hot flashes in breast cancer survivors. Editorialists note that the acute toxicities of venlafaxine could have been minimized — without necessarily diminishing its efficacy — by using a lower starting dose (37.5 mg daily). Despite the double-blind, randomized design of this study, its small sample size remains a limitation; many more participants would be necessary to ensure detection of a difference between these agents relative to placebo. Nevertheless, this study supports use of these agents to improve quality of life in breast cancer survivors who suffer from hot flashes.
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