Alternatives to Hormone Replacement Therapy

The medical community is aware that hot flashes need remediation, and they are trying other types of medication. In an article published in JAMA (p 2057, v 295, 2006) titled "Non hormonal therapies for menopausal hot flashes", the study (actually a meta-study, summarizing several previous studies), the authors consider treatment by antidepressants, anti-hypertensive drugs, isoflavone extracts and other treatments. They find that when all studies are summed, some common antidepressants do have an effect, when compared to a placebo. The number of daily hot flashes is reduced by about one per day - not really spectacular... The actual numbers show an average reduction of 1.1 per day (Margin of Error between 0.6 and 1.7) for antidepressants. For the antihypertensive drug clonidine, the reduction is 1.6 per day, with a Margin of Error between 0.5 and 2.8. For red clover isoflavone extracts, the numbers do not demonstrate a statistically significant effect (reduction of 0.5 hot flashes per day, but with a Margin of Error beween a reduction of 1.5 and an increase of 0.6).

It is noteworthy that these drugs all have significant side effects, and the authors state clearly that "These therapies may be most useful for highly symptomatic women who cannot take estrogen but are not optimal choices for most women" (italics mine). An editorial in the same issue of JAMA notes that hormonal therapy is the most effective remediation, but it should not be used by women at a high risk for blood clots, cardiovascular diesease, and breast cancer.