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And, like hormone replacement therapy, some non-hormone treatments may have adverse effects, making it best to limit their use, the researchers said.

"For women who have mild to minimal symptoms, it would be better to not take anything," said study lead author Dr Heidi D. Nelson, of Oregon Health & Science University in Portland.

The findings appear in the May 3 issue of the Journal of the American Medical Association.

Hormone therapy tied to risks
Interest in non-hormone treatments for menopause symptoms has grown in the wake of the Women's Health Initiative study, which was halted three years ahead of schedule, in 2002, when researchers found a higher risk of breast cancer, blood clots, stroke and heart attack in women on hormone therapy.

For the new research, Nelson and her colleagues did a so-called meta-analysis, pooling and then analysing the results of 43 clinical trials on non-hormone remedies. They looked at the effectiveness of each treatment for hot flushes, a common menopausal symptom.

"We focused on hot flushes, which can be counted," said Nelson.

Various treatments helped
What helped? Antidepressants; the blood pressure medicine clonidine (Catapres); and gabapentin (Neurontin), a seizure medication, all reduced - to some extent - the frequency and severity of hot flushes. Red clover isoflavone extracts didn't make a difference. And results of the studies on soy isoflavones, another popular remedy, were mixed.

The non-hormone treatments didn't provide complete relief, however.

"Clonidine reduced hot flushes by about one a day," Nelson said. The SSRI type of antidepressant, such as paroxetine (Aropax), also reduced hot flushes by about one a day. And gabapentin reduced them by about two a day, she said.

With hormone replacement therapy, there was an average reduction of two-and-a-half to three hot flushes a day, Nelson said. Whether that reduction is worth it depends on how many hot flushes a woman has in a typical day, she said.

Many doctors suggest that women with symptoms severe enough to disturb their life can take the lowest effective dose of hormone replacement therapy for the shortest period of time possible.

Treatments have side effects
In an accompanying editorial in the journal, Dr Jeffrey Tice, an assistant professor of medicine at the University of California, San Francisco School of Medicine, noted that all non-hormonal treatments have side effects. For instance, the antidepressant Aropax can cause headache, insomnia, anxiety and sexual dysfunction. And, he added, in the trials reviewed for the meta-analysis, the treatments were only studied for a few months, so there's no long-term research on their use for hot flush relief.

"All antidepressants aren't created equal," he said. "The one antidepressant with the most consistent evidence [for hot flush relief] is Aropax."

For some women with milder menopausal symptoms, it may be enough to avoid triggers of hot flushes, such as spicy foods, and to drink cool drinks when a flush occurs, Tice said. "Start with that. If you don't need drugs, don't take them," he said.

Nelson also suggested other measures, such as layering clothes and removing them when hot flushes strike.

"Women with disturbing symptoms, if they are not eligible for oestrogen, they should look at these other therapies and perhaps find some relief," she said. – (HealthDayNews)

Visit our Menopause Centre for more information.

May 2006
 

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