Treating recurrent postmenopausal vasomotor symptoms in a patient with a positive family history for breast cancer.

OBJECTIVE: To report a case of recurrent hot flashes unresponsive to gabapentin in a postmenopausal patient with a positive family history of breast cancer. CASE SUMMARY: A 69-year-old Caucasian female experienced a recurrence of debilitating hot flashes for the past eight months. More recently, she failed a two-month trial of gabapentin 600 mg by mouth at bedtime after she previously received effective hormone replacement therapy (HRT) seven years ago with near-complete resolution of her symptoms. The patient had a sister and a niece who developed breast cancer in their 40s. DISCUSSION: The treatment of postmenopausal hot flashes in a patient with a positive family history of breast cancer represents a clinical challenge for many clinicians. This case is an example in which gabapentin was ineffective in the treatment of severe hot flashes in a postmenopausal woman. The risks and benefits of HRT compared with nonhormonal alternatives were assessed. CONCLUSION: In this case, a two-month trial of gabapentin 600 mg/day failed to demonstrate efficacy in reducing the severity, frequency, and duration of hot flashes. Controlled trials are necessary to evaluate the safety and efficacy of other therapeutic alternatives.