Hormone Therapy-Related Hot Flashes

Hormone therapy medications are often used to treat hormone-receptor positive (HR+) 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 lower the amount of certain hormones in your body, such as 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 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 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 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 with hot flashes. These include:

• 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. It is important to 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 fewer side effects.

Your hormone therapy is an important part of your care and you take your medications exactly as prescribed. It is important to let your care team know about any side effects or issues you are having while taking your hormone therapy medication.