A systematic review of non-hormonal treatments of vasomotor symptoms in climacteric and cancer patients

Abstract

The cardinal climacteric symptoms of hot flushes and night sweats affect 24-93% of all women during the physiological transition from reproductive to post-reproductive life. Though efficacious, hormonal therapy and partial oestrogenic compounds are linked to a significant increase in breast cancer. Non-hormonal treatments are thus greatly appreciated.This systematic review of published hormonal and non-hormonal treatments for climacteric, and breast and prostate cancer-associated hot flushes, examines clinical efficacy and therapy-related cancer risk modulation.A PubMed search included literature up to June 19, 2014 without limits for initial dates or language, with the search terms, (hot flush* OR hot flash*) AND (clinical trial* OR clinical stud*) AND (randomi* OR observational) NOT review). Retrieved references identified further papers. The focus was on hot flushes; other symptoms (night sweats, irritability, etc.) were not specifically screened. Included were some 610 clinical studies where a measured effect of the intervention, intensity and severity were documented, and where patients received treatment of pharmaceutical quality. Only 147 of these references described studies with alternative non-hormonal treatments in post-menopausal women and in breast and prostate cancer survivors; these results are presented in Additional file 1.The most effective hot flush treatment is oestrogenic hormones, or a combination of oestrogen and progestins, though benefits are partially outweighed by a significantly increased risk for breast cancer development.This review illustrates that certain non-hormonal treatments, including selective serotonin reuptake inhibitors, gabapentin/pregabalin, and Cimicifuga racemosa extracts, show a positive risk-benefit ratio.Key pointsSeveral non-hormonal alternatives to hormonal therapy have been established and registered for the treatment of vasomotor climacteric symptoms in peri- and post-menopausal women.There are indications that non-hormonal treatments are useful alternatives in patients with a history of breast and prostate cancer. However, confirmation by larger clinical trials is required.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-0808-y) contains supplementary material, which is available to authorized users.

Efficacy of Cimicifuga Racemosa on Menopausal Symptoms in Women with Breast Cancer

“…The Black Cohosh is able to bind to hypothalamic receptors for serotonin, which exert an action similar to the one that this neurotransmitter plays in countering the autonomic symptoms of postmenopausal women [4][5][6]. Currently, the recommended dose should not exceed 80 mg daily [19].…”

“…Conversely, Cimicifuga racemosa (CR) binds to hypothalamic receptors for serotonin, which exert an action similar to the one that this neurotransmitter plays in countering the autonomic symptoms of postmenopausal women [4][5][6]. Indeed, it was used by the North American Indians to tackle a wide variety of women's health issues, including climacteric symptoms [7][8][9].…”

Hilft Traubensilberkerze auch bei Männern gegen Schwitzen durch Hormonentzug?

“…In einer systematischen Übersichtsarbeit [6] formulieren die Autoren ganz allgemein: Verschiedene Studien haben gezeigt, dass Männer, die unter einer Hormonentzugstherapie Hitzewallungen und vergleichbare Beschwerden entwickeln, gut auf die gleichen medikamentösen erapien ansprechen, die bei Wechseljahresbeschwerden von Frauen wirksam sind. Phytopharmaka sind hier allerdings auch bei Frauen von bisher nicht gesichertem Wert [7].…”

“…Auch sind keine nachteiligen Ein üsse auf den Verlauf einer Prostatakrebserkrankung beschrieben. Im Gegenteil: In vitro-und In-vivo-Daten lassen sogar eine positive Beein ussung der Erkrankung vermuten [6].…”

Mind–body interventions for vasomotor symptoms in healthy menopausal women and breast cancer survivors. A systematic review

“…A recent systematic review of non-hormonal treatments of vasomotor symptoms did not include mind-body therapies [16]. Although a systematic review was published previously on this topic [17], it was based on searches which are now seven years old and did not include the more recent RCTs that have utilised CBT based interventions. The inclusion of CBT based interventions is important as behavioural and cognitive components of CBT may provide women with helpful behavioural strategies and awareness of activities that might trigger HFNS.…”