A 48-year-old woman with a history of ER-positive breast cancer is experiencing severe menopausal hot flushes after completing adjuvant aromatase inhibitor therapy. Which non-hormonal treatment has the strongest evidence for vasomotor symptom relief in breast cancer survivors?

• A Venlafaxine 75 mg once daily ✓
• B Clonidine 0.1 mg twice daily
• C Gabapentin 300 mg three times daily
• D Phytoestrogens (isoflavones) 80 mg daily

Explanation

Venlafaxine (SNRI) has the strongest evidence base among non-hormonal treatments for hot flushes in breast cancer survivors, with multiple RCTs showing 60–65% reduction in flush frequency and severity. Gabapentin also shows benefit but has more side effects. Clonidine is moderately effective but poorly tolerated. Phytoestrogens have weak evidence and may have oestrogenic activity, making them potentially unsafe in ER-positive breast cancer. HRT is contraindicated in this population.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.