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Hot flashes: What works?

Estrogen is the most effective treatment for hot flashes in menopause; however, some women fear its side effects and seek other treatment options. The re- sults of a systematic review of placebo- controlled trials of non-estrogen thera- pies suggest that progesterone may have its own positive effect on relieving hot flashes, and selective serotonin re- uptake inhibitor antidepressants and gabapentin also show promising re- sults in small studies. Despite popular use, soy products had inconsistent re- K C

sults, and improvements in hot flash O T S symptoms seen with vitamin E and M O black cohosh were small and delayed. C Red clover, evening primrose oil, gin- Non-estrogen therapies for treating hot flashes. seng root, topical wild Mexican yam and dong quai did not improve symp- toms. Researchers concluded that Self-managing INR Flu vaccine and the elderly more data are needed on alternative therapies, including the long-term ef- UK researchers randomly assigned A systematic review of studies of the in- fects of herbal therapies. Acta Obstet 617 patients to either manage their fluenza vaccine reveals that the vaccine is Gynecol Scand 2005;84:972-9 own warfarin dosing or have their more effective in elderly people living in physician do so. All of the patients homes than in those living in the com- Nasal sprays for rhinitis had already been taking warfarin for munity. For residents of homes, the vac- at least 6 months. Patients in the self- cine reduced rates of -like ill- Researchers in Germany compared the care group used a home testing device ness (vaccine efficacy [VE] 23%, 95% CI efficacy and cost-effectiveness of and pa- to measure their international nor- 6–36), hospital admissions (VE 45%, tient tolerance for 3 nasal sprays used for malized ratio (INR) twice a week and 95% CI 16–64), (VE 46%, seasonal . A total of 123 a simple dosing chart to calculate 95% CI 30–68) and all-cause deaths (VE patients used a (mometa- their dose of warfarin. After 12 60%, 95% CI 23–79). Among elderly sone furoate 200 µg once a day), a topical months researchers found no differ- people in the community there was no ( hydrochlo- ence in the percentage of time pa- improvement in influenza-like illness ride 200 µg twice a day) or the cromone tients spent within the therapeutic rates or in the number of influenza cases disodium cromoglycate (5.6 mg 4 times range of INR in the 2 groups (70% v. or pneumonia, although hospital admis- a day). Users of had 68%). Importantly, there was no in- sions for influenza and pneumonia (VE greater reductions in nasal symptoms crease in serious adverse events (2.8 v. 26%, 12–38) and deaths (VE 42%, 24– (sneezing, itching, runny nose) and in 2.7 events per 100 patient years) 55) were reduced. Researchers conclud- eosinophil protein counts in nasal secre- among patients using self-care. Re- ed that the effectiveness of vaccination tions. Improvement in nasal inspiratory searchers concluded that, with appro- for elderly people in the community is flow was greater in the glucocorticoid priate training, many patients can modest, perhaps because of the difficul- and antihistamine groups. The 3 drugs manage their own anticoagulation us- ties in achieving good coverage in those had a similar impact on eye complaints ing these tools. Of note, only 25% of who need it most. Baseline health differ- related to allergic rhinitis and to side ef- eligible patients participated in the ences between those living in homes and fects. Although glucocorticoids are more trial, perhaps because of the demands in the community may also explain the expensive, improved treatment results of self-care or an unwillingness to par- findings. Lancet 2005;366(9492):1165- meant that it remained cost-effective in ticipate in clinical trials. BMJ 2005; 74 — Compiled by Sally Murray, CMAJ this study. Ann Immunol doi:10.1136/bmj.38618.580903.AE (pub- 2005;95:272-82 lished 2005 Oct 10) DOI:10.1503/cmaj.051515

CMAJ • January 3, 2006 • 174(1) | 23