Hormone Therapy-Related Hot Flashes

Author: Rohit Reddy, Pharm.D. Candidate 2020 (Temple University) and Sweta Patel, PharmD, BCOP
Content Contributor: Carolyn Vachani, MSN, RN
Last Reviewed:

Hormone therapy medications are commonly used for the treatment of hormone-receptor positive breast cancer and prostate cancer. Examples of hormone therapy are:

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

These medicines work by lowering the amount of the hormones estrogen, progesterone, or testosterone in your body. Lower levels of hormones can lead to a few side effects, including hot flashes.  

What are hot flashes?

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

  • A hot flash can make you flushed (skin appears red) or cause you to sweat.
  • You may have a feeling that your heart is racing (palpitations) or you may feel anxious.
  • When the flash passes, you may have chills.
  • A hot flash may 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

If you are having hot flashes, it is important to talk to your provider about it. Tips for lessening hot flashes are:

  • Avoid 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 be helpful.
  • 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 alternative treatment options. 

Medications for Symptom Management 

There are medicines that can help manage hot flashes. These include: 

  • Certain antidepressants can help lessen hot flashes. These include: 
    • 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. 

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 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 manage hot flashes. If these do not help, they may suggest changing to a different hormone therapy medicine. You may be able to take a different medicine and have fewer side effects. 

Your prescribed hormone therapy is an important part of your care. It is very important that you take your medications exactly as prescribed. Hormonal therapy has 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. 

Gupta, A. (2018). Hormone Therapy–Related Hot Flashes and Their Management. JAMA oncology4(4), 595-595.

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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