Breast cancer is one of the most frequent cancers worldwide and its treatment can produce disturbing symptoms including hot flushes, the sudden feeling of heat in the face, neck and chest. Hormonal treatments are used to control such symptoms in postmenopausal women but for women with a history of breast cancer these are not recommended as they can induce cancer growth. The aim of this review is to evaluate the efficacy of non-hormonal interventions in treating hot flushes in such women.
We found 10 randomised controlled studies assessing pharmacological therapies and six assessing non-pharmacological treatments (complementary or alternative therapies). The 10 studies on pharmacological therapies included two on clonidine (an antihypertensive that stimulates a norepinephrine receptor implicated in the initiation of flushes), one on gabapentin (an anticonvulsant that diminishes hot flushes through an unknown mechanism), six on selective serotonin or serotonin-norepinephrine reuptake inhibitors (antidepressants that increase the levels of serotonin and norepinephrine, both implicated in the generation of hot flushes) particularly venlafaxine, paroxetine, sertraline and fluoxetine, and one on vitamin E (mechanism unknown).
Clonidine, antidepressants and gabapentin reduced the number and severity of hot flushes. Vitamin E did not reduce the number or severity of hot flushes.
Of the six studies evaluating non-pharmacological therapies, two were on homeopathy (one evaluated a single homeopathic remedy in a group and the Hyland’s menopause formula in a second group; and the other study evaluated homeopathic medicines in tablet, granule or liquid form, prepared by a single pharmacy), two on relaxation therapy (occupational therapist-guided relaxation consisting in stress management, written information about stress, deep breathing techniques, muscle relaxation and guided imagery), one on acupuncture (eight treatment sessions, 19 acupuncture points) and one on magnetic therapy (magnetic devices attached to participants’ skin, placed over acupuncture or acupressure sites).
In the studies on non-pharmacological therapies, relaxation therapy was the only one that probably reduced the frequency and severity of hot flushes. Homeopathy, acupuncture and magnetic therapy may not lead to any differences in the number and severity of hot flushes.
One limitation of our review is that it is not possible to say if some treatments are better than others. Another limitation is that adverse effects were not clearly reported in all studies. —Cochrane Sept 2010