The Hormone Therapy - Breast Cancer Connection

Alternatives to Hormone Therapy

Antidepressants. These medications aren't approved by the FDA as hot flash remedies, but doctors now prescribe them "off label" for that purpose. Antidepressants work by increasing levels of a brain chemical called serotonin. Nobody knows for sure, but it may be that adjusting serotonin levels affects the part of a woman's brain that controls body temperature, or that serotonin influences levels of a woman's natural estrogen.

Studies show that antidepressants do appear to curb hot flashes but not as well as estrogen. In May 2006 the Journal of the American Medical Association looked at the research to date: Studies showed the class of drugs called selective serotonin reuptake inhibitors (SSRI's such as Paxil) reduced hot flash frequency by about one per day. By comparison, estrogen reduces the frequency of hot flashes by 77 percent or about two and a half to three hot flashes daily compared with placebo. A trial of the drug Effexor showed that low doses didn't have much effect, but higher ones reduced hot flashes by about 60 percent. Women taking large doses also experienced the most side effects, including dry mouth, nausea, and constipation.

Antidepressants can lower libido. But researchers are awaiting more information on a new type of serotonin drug called Pristiq from Wyeth Pharmaceuticals, maker of Effexor, that may not produce this effect. The company filed for FDA approval of this drug in July 2006 as a treatment for hot flashes.

Gabapentin. Sold under the brand name Neurontin, this drug was approved by the FDA to treat epileptic seizures but is also used to relieve severe pain. The drug has shown promise as a hot flash treatment: It reduced by about 50 percent the intensity and duration of hot flashes in a study of 400 breast cancer patients, according to a 2005 study in the medical journal The Lancet. Possible side effects include vision problems, clumsiness, unsteadiness, dizziness, drowsiness, and muddled thinking.

Herbal remedies. Several herbs and supplements are touted for curbing hot flashes. Black cohosh has shown some effect in studies, but other research suggests it does not work any better than a placebo. Soy isoflavones may also help. These contain plant compounds that act like mild estrogens. The impact of long-term use is unknown. Before trying either supplement, discuss it with your doctor. There's no solid scientific evidence to support red clover, dong quai, vitamin E, evening primrose oil, ginseng, melatonin, or wild yam.

Bones are constantly in a state of remodeling, a process that dissolves old bone and builds new bone.

A woman usually reaches peak bone mass by age 30. After that she starts to lose more bone than she makes. Bone loss (but not rebuilding) speeds up dramatically during the 10 years after the onset of menopause. Taking calcium plus vitamin D and doing regular weight-bearing exercise are important non-hormonal ways to strengthen bones. One widely used prescription medication for weak bones is a class of bone drugs called bisphosphonates, which stop the breakdown part of the bone-remodeling process. These drugs have been shown to increase a woman's bone density and lower her risk of fracture. But there are questions about the safety and efficacy of these drugs long term. Also ask your doctor about the bone-building drugs raloxifene, calcitonin, and parathyroid hormone.

Some doctors prescribe sleep medications for women who complain of sleep problems owing to menopause. Check with your doctor about whether (and how long) you could safely use these drugs.

Tara Parker-Pope is the author of The Hormone Decision, Rodale Books, 2007.

Originally published in Ladies' Home Journal, February 2007.