An alternative to estrogen for hot flashes is studied


November 01, 1994|By Dr. Simeon Margolis | Dr. Simeon Margolis,Special to The Sun

Q: Since my menstrual periods stopped several months ago, I have been greatly troubled by hot flashes. I had one breast removed because of breast cancer two years ago, and my gynecologist will not prescribe estrogen replacement to stop my symptoms because she is afraid it will make the breast cancer recur. Is there any safe treatment for my hot flashes?

A: A recent report of a study organized by investigators at the Mayo Clinic has shown that small doses of an alternative to estrogen called megestrol acetate improved the symptoms of hot flashes in postmenopausal women.

In this study, 97 women with a history of breast cancer were given either 20 milligrams of megestrol acetate daily for four weeks, followed by a placebo (sugar pill) for four weeks, or were first given the placebo and then the hormone. The frequency and severity of hot flashes were reduced at least by half in 73 percent of the women during the last week they were taking the hormone compared with a reduction of only 26 percent when taking the placebo.

The improvement in hot flashes by megestrol acetate may not be evident until the medication has been taken for two to three weeks, and the benefits may persist for several weeks after medication is discontinued.

Many physicians agrees with your doctor that estrogen should not be given to women with a history of breast cancer. Megestrol acetate seems to be a suitable alternative. Even though no studies have directly examined the possibility that small doses of megestrol acetate might stimulate the growth of breast cancer cells, the available evidence suggests that this hormone is more likely to inhibit, rather than stimulate, the growth of breast cancer.

The same study evaluated the effects of megestrol acetate in men who had hot flashes after treatment for metastatic prostate cancer with surgical removal of both testes or treatment with drugs to suppress their formation of testosterone and other male sex hormones. The megestrol acetate improved hot flashes in these men to the same extent as in the postmenopausal women.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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