Practicing Safe Soy

Hot Flashes

Estrogens is the treatment of choice for women experiencing menopausal symptoms. However estrogen has been postulated as a promotor of breast cancer. Women, surviving breast cancer, are reluctant to take hormone replacement therapy and are advised against it by their physicians. In addition, hot flashes, occurring after a chemically-induced menopause, can be more severe and debilitating, Therefore, women and their physicians are looking towards other agents and remedies that will provide relief of their symptoms.

The following article is a study looking at soy to reduce hot flashes.

Soy Does Not Improve Hot Flashes

Hot flashes are a common complaint of women undergoing treatment for breast cancer using chemotherapy drugs or taking the anti-estrogen, tamoxifen. A hot flash is described as a transient episode of flushing, sweating, and a sensation of heat, often accompanied by palpitations and a feeling of anxiety, and sometimes followed by chills. Phytoestrogens, such as soy products have been used to mitigate these symptoms and have been used successfully, anecdotally.

In a double blind randomized trial conducted by the North Central Cancer Treatment Group and published in the March 2000 issue of the Journal of Clinical Oncology, soy did not alleviate hot flashes in breast cancer survivors.

There were a total of 182 women entered into the protocol and 149 women were evaluated with complete data. Using different methods of statistical analysis, the number and severity of hot flashes was evaluated on a daily basis, over a 9 week period. There were 2 groups comprising 87 and 88 women. In each group, sixty eight per cent of women were currently on tamoxifen. One group started with soy - - ingesting 150mg isoflavones daily (50mg tablets, three times daily) then in week 5 crossed over to placebo. The second group started with placebo and crossed over to soy. When both groups were compared, there was no statistically significant improvement in hot flashes while on soy supplements.

The following is a Table listing an Overview of Non-Hormonal Agents for Hot Flashes which has been reprinted as recommendations from the National Surgical Adjuvant Breast Project – STAR (Study of Tamoxifen and Raloxifene) trial. Some of these agents however have produced marginal results at best.

Agent

Classification

Dose

Mechanism of Action

Side Effects

Vitamin E

Vitamin

800 IU po daily

Prevents excessive FSH and LH production

None at this dose

Vitamin C plus bioflavinoids (Peridin C ®)

Bioflavinoid

2 tablets po tid

Enhances capillary tone

Perspiration may have an unpleasant odor.

Clonidine
(Catapres ®)

Alpha-adrenergic agonist

0.005 mg po bid (may increase to 0.1mg bid if hot flashes persist)

Reduces vascular reactivity, stabilizes thermoregulatory center

Hypotension, dizziness and fatigue

Clonidine Transdermal Patches (Catapress-TTS ®)

Alpha-adrenergic agonist

0.1 mg patches, change weekly

Reduces vascular reactivity, stabilizes thermoregulatory center

Hypotension, dizziness and fatigue

Phenobarbital-bella donna-ergotamine combination (Bellergal-S ®)

Autonomic stabilizer

1 po at hs, if innefictive, 1 po bid

Inhibits adrenergic and cholinergic impulses locally

Dry mouth, dizziness, drowsiness, addictive potential

Venlafaxine (Effexor ®)

Antidepressant

12.5 mg po bid

Inhibits neuronal serotonin and norepinephrine re-uptake

Anxiety, nervousness, insomnia (minimal at this dose) potential interaction with MAO inhibitors

Paroxetine
(Paxil ®)

Antidepressant

10 mg po daily for 1 week, then 20mg daily

Selectively inhibits re-uptake of serotonin

Somnolence

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