Hormone Therapy-Related Hot Flashes

Author: Rohit Reddy, Pharm.D. Candidate 2020 (Temple University) and Sweta Patel, PharmD, BCOP
Last Reviewed: March 12, 2020

Hormone therapy medications are commonly used for the treatment of hormone-receptor positive breast cancer. Tamoxifen and aromatase inhibitors (AIs) including anastrozole (Arimidex®), letrozole (Femara®), and exemestane (Aromasin®) are all examples of hormone therapy medications. These medications work by reducing the level and/or activity of the hormones estrogen and progesterone. When there is less estrogen in the body it can lead to a number of different side effects, including hot flashes.  

What are hot flashes?

Hot flashes are on and off episodes of flushing and sweating that can happen many times in a day. You may feel suddenly hot or flushed in your face or body. During a hot flash you may have palpitations (a feeling that your heart is racing) or anxiety, and this may sometimes be followed by chills. On average, hot flashes may last for as little as 30 seconds or for up to 10 minutes.

What causes hormone-therapy related hot flashes? 

The exact cause of hormone-therapy related hot flashes is not fully understood. However, it is known that hormone therapy for breast cancer reduces the level or activity of estrogen and progesterone in the body. It is believed that the lower level of estrogen is the reason for these hot flashes, similar to when women undergo menopause.

Who is at risk of developing hot flashes?

It is not fully known which patients may be at higher risk of having hot flashes. Younger women do report a greater number of hot flashes during hormonal therapy than older women. Certain chemotherapy regimens can lead to early menopause which can lead to hot flashes even before you start hormonal therapy. 

Managing Hot Flashes

If you are having hot flashes it is important to talk to your provider about it. Lifestyle changes such as avoiding triggers and keeping your core body temperature cool may help manage some of these symptoms. This can mean reducing or avoiding stress, alcohol, caffeine, spicy foods, hot showers and smoking. In addition, dressing in loose fitting clothes, keeping your home and bedroom cool, as well as keeping an ice pack underneath your pillow may help prevent hot flashes. Complementary and alternative therapy such as herbal supplements, relaxation training, hypnosis, and other therapies may help but this has not been proven. Acupuncture may be helpful. Talk with your provider before starting any new herbal supplements or alternative treatment options. 

Medications for Symptom Management 

There are medications that can help manage hot flashes that are also used for other health issues. These include: 

  • Antidepressants including selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil) and citalopram (Celexa), and serotonin norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor). 
  • Gabapentin (Neurontin), pregabalin (Lyrica), clonidine (Catapres) and oxybutynin may help with hot flashes as well. 

Keep in mind these medications have their own risks, side effects, and interactions. It is important to talk to your provider about your medical/medication history in order to find the best treatment choice for you.

Switching Hormonal Therapy 

One way to help with hot flashes while on hormonal therapy for breast cancer is to switch from one therapy to another. Studies have shown that patients who cannot tolerate one hormonal therapy due to side effects may be able to be successfully treated with another hormonal therapy. If you begin to have hot flashes and it interferes with you taking your hormonal therapy medication make sure to speak to your provider right away. Your provider will review your medical and medication history and if possible start you on a different medication. 

Your prescribed hormonal therapy is an important part of your care. It is very important that you take your medications exactly as prescribed. Hormonal therapy does have its side effects, such as hot flashes. It is important to let your medical team know about any side effects or issues you are having while taking your hormone therapy medication.   

References

Dalal S, Zhukovsky DS. Pathophysiology and management of hot flashes. J Support Oncol. 2006; 4(7): 315-320. 

Henry NL. Endocrine therapy toxicity: management options. ASCO Educational Book. 2019.

Lyman GH, Greenlee H, Bohlke K, et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO Clinical Practice Guideline. J Clin Oncol. 2018; 36: 2647-2655. 

Gibbs TM. Breast cancer survivors & hot flash treatments. The North American Menopause Society website.  https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/breast-cancer-survivors-hot-flash-treatments. Accessed February 20, 2012.

PDQ® Supportive and Palliative Care Editorial Board. PDQ Hot Flashes and Night Sweats. Bethesda, MD: National Cancer Institute. Updated January <01/08/2020>. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/hot-flashes-pdq. Accessed <02/20/2020>.

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