More than 50 percent of women entering into menopause know the feeling all-too-well. That sudden rush of uncomfortable and often embarrassing heat that seems to take over your body, causing your heart to race and your skin to redden. To control hot flashes in the past, women used estrogen replacement therapy during this natural stage of menopause. However, recent concerns about the safety of estrogen use have left many women looking for alternatives.
Breast cancer oncologists at the University of Michigan Comprehensive Cancer Center have been searching for another way to treat hot flashes -- by studying a popular drug type used for the treatment of depression.
The search for an alternative treatment for patients who suffer from hot flashes and have a history of breast cancer has been going on for several years by investigators who are now at the U-M Cancer Center.
"In the breast cancer field, we've been concerned for years about giving estrogen replacement therapy to women who have a history of breast cancer," says Daniel F. Hayes, M.D., clinical director of the Breast Oncology Program at the U-M Cancer Center. U-M breast cancer oncologist knew that the use of estrogen increased the risk of a woman developing certain forms of cancer, including breast cancer.
Although the exact triggers for hot flashes are not completely understood, experts do know that they are a result of a decrease in the female hormone estrogen during menopause. It's believed that estrogen production affects the part of the brain that controls the body's temperature. The body's "thermostat" prevents us from overheating or freezing in various environments.
"With menopause, there's a lack of estrogen that causes this thermostat to become irregular, which causes women to be substantially sensitive to temperature changes that would normally not bring about a sudden change in the body's temperature," explains Hayes.
That's why estrogen replacement therapy had previously been so successful in treating hot flashes. Estrogen helps reduce the incident of hot flashes almost completely in 80 percent to 90 percent of women.
But with concern over the safety of estrogen replacement therapy, especially for women who have had breast cancer, it became important to find a safer, non-hormonal treatment.
In a step toward finding an alternative treatment for hot flashes, experts from several different centers have discovered that a class of drugs used to treat depression may be an effective treatment. The drugs, called selective serotonin re-uptake inhibitors (SSRI), work well because with depression and hot flashes, serotonin, a major neurotransmitters found in the synapses of the brain, isn't functioning correctly.
Several SSRI drugs, such as Prozac, Paxil and Effixor, decrease hot flashes in about 50 percent of women. So, while SSRI drugs are not as effective as estrogen, they appear to perform better than a placebo.
Hot flash study participant Deborah Stafford has noticed a steady decrease in her hot flashes once she began taking Paxil. Initially, Stafford came to the U-M Health System after being diagnosed with breast cancer. That diagnosis then led to her taking a drug called Tamoxifin, which is commonly used to stop estrogen production in breast cancer patients. But immediately after she began taking the drug, the hot flashes started.
"We laugh about hot flashes, but really they're quite uncomfortable," Stafford explains. "My face would turn red, it would look rather moist and sometimes they actually made me feel exhausted. It was very hard to work through them."
After participating in the two-month study, Stafford says she feels like herself again and plans to continue to take Paxil to control her hot flashes.
For women who don't want to take drugs, there are still other options to help control hot flashes such as soy. However, Hayes warns that soy does contain a weaker estrogen-like product and there is little known about its effects.
Since the Food and Drug Administration (FDA), does not tightly regulate a lot of drug additives and natural remedies, Hayes further suggests that you talk with your health care provider before you decide to use drug additives or natural remedies.
