Nonhormonal Drugs Not As Effective As HRT In Reducing Hot Flashes In Menopausal Women, Study Review Says

Main Category: Menopause
Also Included In: Endocrinology
Article Date: 05 May 2006 - 3:00 PDT

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Nonhormonal medications -- such as antidepressants, antihypertensives, antiepileptics and those containing isoflavone extracts -- are not as effective as estrogen and other hormone replacement therapies in reducing the number of hot flashes in menopausal women, according to an analysis of 43 previous studies published in the May 3 edition of the Journal of the American Medical Association, Reuters Health reports. Heidi Nelson, an internist and professor at Oregon Health and Science University, and colleagues examined data from 10 studies involving antidepressants; 10 studies involving the antihypertensive clonidine; six studies involving other prescription medications, including the antiepileptic gabapentin; and 17 studies involving isoflavone extracts, which comes from red clover and soy (Rauscher, Reuters Health, 5/2). According to the New York Times, none of the drugs or extracts studied is FDA-approved to treat hot flashes -- only hormones are FDA-approved for the condition -- but physicians can prescribe them for treatments off label. The study finds that antidepressants and clonidine reduce the number of hot flashes in menopausal women by an average of about one daily, while gabapentin reduces the number by about two daily (Grady, New York Times, 5/3). Isoflavone extracts appeared to have no significant effect on the number of hot flashes, according to Nelson (Dworkin, Oregonian, 5/3). Researchers also found that HRT reduces the number of hot flashes "by approximately 2.5 to 3 per day," Nelson said. In addition, the side effects and cost of nonhormonal therapies might limit their use in reducing hot flashes, according to the study (Reuters Health, 5/2). Nelson said there is little reliable data on drugs that treat hot flashes, according to the Times. For example, of the 10 studies on antidepressants, researchers found only two of the studies to be conclusive, while the rest were rated fair or poor, which, according to the Times, could mean a variety of things, such as a data set was too small to be conclusive. Nelson said, "If there were only 20 women in the study, how do we say it's appropriate for all the women in the country?"

Reaction, Recommendations
HRT "fell from grace" after a U.S. government study in 2002 found the therapy increased a woman's risk of developing breast cancer, stroke, blood clot and heart attack, the Times reports (New York Times, 5/3). The researchers concluded that nonhormonal drugs "may be most useful for highly symptomatic women who cannot take estrogen but are not optimal choices for most women" (Nelson et al., JAMA, 5/3). Nelson added, "There's always a lot of hype around trying things that we haven't proven effective, and, sadly, we haven't proven [nonhormonal therapies] safe" (New York Times, 5/3). In a related JAMA editorial, Jeffery Tice and Deborah Grady of the University of California-San Francisco write that HRT should be avoided by women who have a higher risk of adverse effects from the therapy but add that HRT is more effective than nonhormonal therapies (Reuters Health, 5/2). Tice and Nelson said they would recommend that women who have unbearable menopausal symptoms take antidepressants over HRT. Tice also said that the drugs should be used only for a short time, after which women should try to stop the treatment. About half of women experience hot flashes during menopause and about 20% of them seek treatment, according to researchers' estimates (New York Times, 5/3).

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