Hot Flashes
Hot flashes—the sudden, intense rush of heat to the face and upper body that can leave you perspiring and feeling flushed—occur when changing hormone levels interfere with the body’s ability to regulate its temperature. In pre-menopausal women undergoing chemotherapy for breast cancer, ovarian function often stops, leading to very low levels of circulating estradiol (a hormone), which results in vasomotor instability. Translation: hot flashes.
Hot flashes also are a side effect of hormone therapies such as tamoxifen (Nolvadex®), and aromatase inhibitors including anastrozole (Arimidex®), exemestane (Aromasin®) and letrozole (Femara®). Tamoxifen triggers hot flashes due to its estrogen antagonist properties that block the effect of estrogen in blood vessels. Aromatase inhibitors, used in post-menopausal women, reduce already low levels of estradiol produced in the body’s fat tissues.
"Hot flashes with natural menopause usually decrease in frequency and severity over time,” says Kathryn Edmiston, M.D., a medical oncologist and associate director of the Comprehensive Breast Center at UMass Memorial Health Care in Worcester, Mass. “This is not necessarily true of hot flashes associated with hormone therapies.” On the positive side, however, she says hot flashes occur in only 30 to 40 percent of women taking tamoxifen and aromatase inhibitors, and are not disabling for most.
There is also good news when it comes to options for controlling hot flashes. First among them: simple lifestyle changes. Dr. Edmiston suggests using a personal fan (battery-operated or manual), wearing lightweight cotton clothing and sleepwear (avoid less-breathable fabrics such as synthetics and silk), dressing in layers (avoid turtlenecks), keeping hydrated and exercising regularly. A low-fat diet helps some women, as does losing excess weight.
Another important strategy is to identify and avoid the activities or circumstances that trigger hot flashes. Experts advise keeping track of when hot flashes occur and what you were doing, eating or feeling at the time. Stress (hard to avoid when undergoing breast cancer treatment) is a leading trigger—underscoring the value of relaxation and stress-reduction techniques such as massage, breathing exercises, meditation, yoga or biofeedback. Other frequent triggers include consumption of alcohol, caffeine, hot and/or spicy food, and smoking.
Pharmacology is the next line of defense. Hormone replacement therapy (HRT), which helps control hot flashes in menopausal women, is not an option for women undergoing breast cancer treatment because the estrogen could stimulate cancer growth. As a result, researchers have developed several nonhormonal treatment options.
Dr. Edmiston may recommend that her patients take vitamin E daily, antidepressants or other prescription medication. Several antidepressants have been studied in placebo-controlled trials for their effect on hot flashes specifically in breast cancer survivors. Check with your medical team, if applicable, to find the medication that is best for you.
What about “natural” therapies such as acupuncture, herbs and plant estrogens such as soy, evening primrose oil, black cohosh and wild yams? “Somehow, ‘natural’ is perceived as better than pharmacologic,” says Dr. Edmiston, who notes that women with breast cancer frequently seek alternative therapies. Their relative safety in women who have had breast cancer is not known, however. Experts advise using them with great caution—and never without telling your physician.
"There is a huge placebo effect to interventions, so it is very important for women to work closely with their doctors to identify triggers, lifestyle changes and modifications that may impact their symptoms,” Dr. Edmiston adds.
This article was first printed in Lifeline.
Think your experience is uncommon? Want to speak with someone who has gone through a similar one? Call the YourShoes 24/7 Breast Cancer Support Center at 1-800-221-2141 and speak with a trained peer counselor who is a breast cancer survivor.