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nosurrender

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From this month's CURE magazine

Hot Flashes: What Are the Alternatives?

Sue Holmes, RN, a breast health coordinator at the deNicola Breast Health Center in Nashua, New Hampshire, was diagnosed at 54 with estrogen receptor-positive noninvasive breast cancer seven years after starting hormone replacement therapy, or HRT, for her symptoms of menopause. “Everybody was taking HRT, then the pendulum swung the other way, and nobody was taking HRT.”

After her diagnosis, Holmes was immediately taken off HRT and her menopausal symptoms returned with a vengeance. “It seemed even worse than I remembered it,” Holmes says. “I was miserable, absolutely miserable. I had terrible hot flashes. I couldn’t think, I couldn’t sleep at night. It was not a good way to live.”

After the Women’s Health Initiative, a large study that examined the effects of combined estrogen and progestin, showed HRT increased the risk of breast cancer, survivors were told to abandon their pills to prevent recurrence. But with few alternatives to combat hot flashes, many survivors feel they must decide between risk of recurrence and quality of life.

Charles Loprinzi, MD, a medical oncologist at Mayo Clinic Cancer Center in Rochester, Minnesota, and a member of the North American Menopause Society, says it doesn’t have to be an either-or decision. While other treatments may not be as effective as HRT, researchers are actively looking at other possibilities to find what works and what doesn’t. Here’s what they’ve found.

Antidepressants

Studies have shown two types of antidepressants—selective serotonin reuptake inhibitors, or SSRIs, and serotonin-norepinephrine reuptake inhibitors, or SNRIs— can reduce the severity and frequency of hot flashes. Effexor (venlafaxine), an SNRI, has the least interference with tamoxifen and has shown effectiveness for hot flashes, decreasing the symptom by 60 percent in more than half of women with hot flashes compared with placebo.

Paxil (paroxetine), an SSRI, decreases hot flashes by up to 70 percent, but new studies show Paxil may interfere with the activity of tamoxifen in some women. Zoloft (sertraline) and Prozac (fluoxetine), also SSRIs, have shown benefit, but not as much as the other antidepressants.

Neurontin

While Neurontin (gabapentin) is marketed as an antiseizure medication, there are several published placebo-controlled trials that have found it can reduce hot flashes by half. Additional data demonstrate a high dose of the drug might reduce hot flashes a bit more. Dr. Loprinzi recently completed a study of Neurontin to combat hot flashes in prostate cancer patients, and found hot flashes were reduced by almost half compared with about 25 percent reduction with placebo.

Integrative Therapies

A clinical trial looking at vitamin E and the frequency of hot flashes showed a slight positive effect, says Dr. Loprinzi. Soy and black cohosh have anecdotal evidence as a treatment for hot flashes, but more definitive trials demonstrate that these agents do not appear to be any better than placebo. Because some natural remedies also have potential phytoestrogenic properties (estrogen-like properties seen in natural plant compounds), some physicians advise caution to survivors considering taking large doses for hot flashes.

Acupuncture has been widely studied, but a Mayo Clinic study published early this year found no additional benefit of acupuncture compared with placebo. Several clinical trials for hot flashes involving acupuncture and other integrative therapies in breast cancer survivors are currently ongoing.

Trial by Fire

Breast cancer survivors have numerous non-HRT options to treat hot flashes, but it may take time to find the single or combination therapy that works best, says Dr. Loprinzi.

Holmes, who tried vitamin E, antidepressants, black cohosh, and other remedies, says they either didn’t work or she developed side effects. Because her cancer was non-invasive, her doctor prescribed a very small dose of estrogen in addition to small doses of progestin delivered directly to the uterus through an intrauterine device to relieve her hot flashes, a regimen that has been studied fairly recently.

Holmes understands she’s taking a risk, but says it’s one she made based on her individual history. “If I had had invasive breast cancer, would I do it? I’m not sure. But I still think you’ve got to balance quality of life with your situation.”

Molly Lindell, on the other hand, a three-year survivor of invasive breast cancer, went cold turkey after her diagnosis in 2004. She worked with her doctor to find the right drug combination to decrease her severe hot flashes. When the first two antidepressants she tried failed to reduce her symptoms, her doctor recommended another SSRI and a benzodiazepine, an older class of antidepressant, along with Neurontin. —EW

 




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nosurrender

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PLEASE NOTE:
CURE MAGAZINE IS FREE FOR ALL CANCER SURVIVORS
IT IS A GREAT RESOURCE OF UP TO THE MINUTE INFORMATION.


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Harley

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No surrender:

I subscribed to CURE... It is supposed to be FREE, and I have only received ONE issue... is it monthly or quarterly??

Also, I subscribed to HEAL, as I read that it was FREE also.  I just got an issue My FIRST, yesterday... it says it is my last FREE issue... I would have to buy it.  I guess I'll wait and see if I ever get another CURE... 

How do you make sure that you get your magazine, if it is a FREE magazine?


samdah

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The CURE Magazine has been replaced by HEAL.

If you go to their website, you have to sign up with the contact information for your doctor so they can confirm that you are a cancer patient and then you get it for free.

I signed up 5 years ago with CURE and it still comes to me for free today (now as HEAL)



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Karen1956

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Sam - I thought cure and heal were two different magazines.  I get both.  I too got a notice saying that it was my last free issue of heal and in the heal magazine it mentioned that cure is free.  Heal has a two for one right now in the magazine.  They are both quarterly.  Hugs, Karen
Harley

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WOW!

I CAN NOT believe it!  So, if CURE is NOW  HEAL, I just got... my last FREE issue...  I think just on principal, I won't be subscribing, if I have to PAY for my FREE magazine!!! 

Terrible!   What next??

Harley
bac10

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I had taken Premarin for fifteen years before my diagnosis in August 2007.  My doctor told me to stop taking it the day he gave me the BC news because I am ER positive and invasive.  Miserable doesn't even describe how I felt. 

I started taking Effexor for depression several months ago and the night sweats became much, much worse.  I got up in the middle of the night not too long ago, changed clothes and did some research on night sweats to find that one of the leading causes is anti depressants and Effexor was named.  I've stopped taking it now (and the depression and crying jags are back) but the night sweats are better...not gone but not drenching.   I sure wish they could find something to help us with this that doesn't cause unreasonable side effects.  

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Hi Bev,

I had been taking hormones for six years before my dx (total hysterectomy).  Of course they took them away from me right away!  That was exactly a year ago.  I've found that the hotflashes diminish with time.  They were really bad, night and day.  They're gone now.  I think my body adjusted to being without estrogen, like normal menopause.

But, I saw my PCP today and will give Tamox another try, starting at 5 mg and working up.  Hopefully, I'll be able to tolerate it this time around.  I'll let you know if the hotflashes come back.

I take Celexa for depression.  As far as I know, it doesn't have any effects on hotflashes ... didn't for me, but it helps with depression.  Effexor isn't the only good med out there for depression.  Another might be of benefit for you.

Bren






Karen1956

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Reply with quote  #9 

Neurontin really helps with the hot flashes and especially with the night sweats.  I started it for joint pain and one week I didn't take it and the night sweats were back - had forgotten about them.  I take 1800mg of Neurontin at bed time.  Karen

bac10

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I had a partial hysterectomy 18 years ago (uterus only).  The premarin completely took care of the hot flashes so I sure do miss it.  Just not enough to feed the beast. 

I'm definitely not giving up on anti depressants.  The constant crying irritates me and I don't have any control over it. 

Thanks for the Neurontin info.  I'm writing all of this down and will talk to the doctor about it. 

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Reply with quote  #11 
I found relief with Turmeric and Fish Oil.



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SoCalLisa

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Reply with quote  #12 
Neurontin worked for me too...

And I have switched to Lyrica and I still don't have them again


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