Hot Flashes and Advanced Breast Cancer Treatment

Hot flashes (or hot flushes) and night sweats often affect people during the transition to menopause (perimenopause), shortly after menopause, and even years after menopause. However, many people undergoing treatment for advanced breast cancer may experience hot flashes and night sweats as a side effect of their treatment. Hot flashes and night sweats are also called vasomotor symptoms.¹

Hot flashes and night sweats are episodes of intense heat that are accompanied by flushing. This can include redness of the face, chest, back, and/or neck and sweating. The processes that cause these symptoms are not fully understood. However, experts think hormones and dysfunction in how the body regulates its internal temperature (thermoregulation) play a role.¹

These symptoms are often bothersome. For some people, they can be extremely uncomfortable or debilitating. Night sweats also disrupt sleep quality, which can cause tiredness and irritability. Vasomotor symptoms can occur often and have a negative impact on quality of life.¹

Hot flashes with breast cancer treatment

Several breast cancer treatments may cause vasomotor symptoms as a side effect. Some treatments suppress natural hormones, including some chemotherapy drugs, hormone therapy, or surgical removal of the ovaries (oophorectomy). These treatments may prematurely cause a person to go into menopause. This is called cancer therapy-induced menopause. The intensity of hot flashes in these people may be more severe than those who have had natural menopause.²

Treatments like hormone therapy and aromatase inhibitors (AIs) often cause hot flashes. Clinical trials that studied the hormone therapy drug tamoxifen have found that up to 80 percent of women experience hot flashes with this treatment. About 30 percent of those defined these symptoms as severe.^2,3

AIs may also cause hot flashes. However, clinical trials comparing AIs with tamoxifen found hot flashes with AIs were less severe. For many women, these side effects may improve over time and stabilize after 3 months of therapy.^2,3

Managing hot flashes from breast cancer treatment

For many menopausal people experiencing vasomotor symptoms, hormone replacement therapy (HRT) can be effective. However, HRT is typically not recommended for people who have previously had breast cancer. Managing hot flashes from breast cancer treatment may include several methods.³

Non-hormonal drugs

Non-hormonal drugs that may help reduce vasomotor symptoms include:³

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)

However, these drugs may cause other side effects, such as dry mouth, headache, nausea, or insomnia. Some of these drugs should not be taken with certain hormone therapies.³

Clonidine and gabapentin are 2 other drugs that have been shown to reduce hot flashes in people with breast cancer. Low doses of clonidine, which is often used to treat high blood pressure, may reduce hot flashes. However, it can cause side effects like dizziness and dry mouth. Gabapentin is used to treat seizures and reduce nerve pain, though it may be used to treat hot flashes. Common side effects of gabapentin include dizziness, unsteadiness, fatigue, and sleepiness.⁴

Lifestyle changes

Lifestyle changes may also help reduce menopause symptoms like hot flashes. This includes things like:^3,5

• Weight loss in those who are overweight or obese
• Smoking cessation
• Limiting or avoiding alcohol
• Eating a healthy diet
• Exercising regularly

Complementary therapies

Complementary methods like hypnotherapy and acupuncture may also improve symptoms. The herb black cohosh may also offer some benefit. However, research studies on this therapy have shown mixed results.^3,4

Talk to your doctor before starting any new drugs, lifestyle changes, and complementary methods. They can help you decide the risks, benefits, and whether they are right for you.