Hormone Therapy-Related Hot Flashes

Hormone therapy medications are often used to treat hormone-receptor positive (HR+) breast cancer, prostate cancer, and some gynecologic cancers. Examples of hormone therapy are:

• Tamoxifen (Nolvadex^®).
• Aromatase inhibitors (AIs) such as anastrozole (Arimidex®), letrozole (Femara^®), and exemestane (Aromasin®).
• Gonadotropin-releasing hormone blockers (GnRH blockers) such as leuprolide (Lupron^®).

These medicines lower the levels of certain hormones in your body, like estrogen, progesterone, or testosterone. Lower levels of hormones can cause side effects, including hot flashes.

What are hot flashes?

A hot flash is a sudden feeling of warmth or heat, often in your upper body (face, neck, chest).

• A hot flash can make you flushed (skin looks red) or cause you to sweat.
• You may have heart palpitations (feeling like your heart is racing or skipping a beat) or you may feel anxious.
• When the flash passes, you may have chills.
• A hot flash can last as little as 30 seconds or for up to 10 minutes.
• They can happen at any time of day, even while you are sleeping, which can cause you to wake up.

Managing Hot Flashes

It can help to keep track of how many hot flashes you have, when they happen, and how long they last. Talk to your provider about them. Tips to help with hot flashes are to:

• Stay away from things that cause you to have a hot flash. These can include warm rooms, hot showers, tobacco, spicy foods, and caffeine or alcohol in food or drinks.
• Try to keep your room cool, even while sleeping. Use a fan or air conditioning or open windows. Wear light, loose-fitting cotton clothing in layers so you can take a layer off when you have a flash.
• Regular exercise including aerobic exercise (walking, running, biking) and strength training, can help.
• Herbal supplements, relaxation training, hypnosis, and other therapies may help but these have not been proven. Acupuncture may be helpful. Talk with your provider before starting any new herbal supplements or other treatment options.

Medications for Symptom Management

Some medicines can help with hot flashes, such as:

• Certain antidepressants can help lessen hot flashes:
  • Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil) and citalopram (Celexa).
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor).
• Other medicines that may help include gabapentin (Neurontin), pregabalin (Lyrica), clonidine (Catapres), and oxybutynin.

These medications have their own risks, side effects, and interactions. Talk to your provider about your medication history to find the best treatment choice for you.

Switching Hormonal Therapy

If your hot flashes are causing you to not take your hormone therapy medicine, speak to your provider right away. Your provider can help you find ways to help with hot flashes. If these do not help, they may try changing to a different hormone therapy medicine. You may be able to take a different medicine and have less side effects.

Your hormone therapy is an important part of your care. Take your medications exactly how your provider tells you to. It is important to tell your provider about any side effects or issues you are having while taking your hormone therapy medication.