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Hypnosis and hot flashes: When will they ever learn?

Posted in Respectful Insolence by Skepdude on October 8, 2008

For women undergoing menopause, hot flashes are a real problem. In my specialty, as I’ve pointed out before, women undergoing treatment for breast cancer are often forced into premature menopause by the treatments to which we subject them. It can be chemotherapy, although far more often it’s the estrogen-blocking drugs that we use to treat breast cancers that have the estrogen receptor. Estrogen stimulates such tumors to grow, and blocking estrogen is a very effective treatment for them, be it with tamoxifen or the newer aromatase inhibors like Arimidex. The utterly predictable consequence, unfortunately, is an artificially-induced menopause.

I’ve written at least twice before about this topic in the context of various poorly designed studies of acupuncture for breast cancer-induced hot flashes. There’s a reason for this. Despite studies demonstrating that hormone replacement therapy doesn’t decrease cardiovascular disease in postmenopausal women and increased the risk of breast cancer, for severe menopausal symptoms in women without breast cancer, estrogen remains the gold standard, and it’s reasonably safe to use for short periods of time. Consequently, for menopause having nothing to do with breast cancer, estrogen can be used, at least for the short term, if nonhormonal therapies don’t work. Not so in the case of women rendered menopausal by breast cancer therapy. Indeed, it defeats the purpose of antiestrogen drugs to replace the estrogen they are blocking. Not only that, but even after breast cancer therapy when a woman undergos menopause naturally, estrogen replacement increases their risk of a recurrence. Consequently, if nonhormonal methods supported by science don’t work, then there’s nothing else, and, unfortunately, most science-based nonhormonal therapies such as antidepressants do not work very well and have significant side effects.

That’s where the temptation to turn to woo comes in.

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