Breast Cancer Health

Keeping Your Cool: The Facts About Hot Flashes

Hot flashes affect most women at some point in their lives. They're the most common symptom associated with menopause (the transition from the reproductive stage of life to the nonreproductive stage that occurs around the age of 51), and research shows that up to 80% of women in Western countries experience them.

But menopausal women aren't the only ones who have hot flashes (also called hot flushes): Between 55% and 65% of breast cancer survivors also have these sudden "heat waves." What's more, women with breast cancer are likely to have more intense flashes than women who undergo a natural menopause. Hot flashes in these women may be due to the effects of chemotherapy on the ovaries, side effects of using hormonal agents, or a result of surgery that removes the reproductive organs and throws them into an abrupt, early menopause. By the age of 50, 1 in 50 women will get breast cancer; by the age of 80, 1 in 10 will get it. It is also important because so many women believe they are at risk for breast cancer: Numerous consumer surveys find that women believe breast cancer is their number 1 health risk, ahead of the true leading cause of death, heart disease.

What Do Hot Flashes Feel Like?

Hot flashes come on suddenly. They start with an unexpected feeling of warmth or heat, and typically spread from the top of the head down toward the feet-almost as if your body is being dipped in hot wax, head first. Most hot flashes affect the scalp, face, and neck, but some can be felt throughout the whole body. Along with the sensation of heat, you might begin to sweat, your face may become flushed or you may blush, and your heart may race. Some women feel anxious, panicky, or dizzy during a hot flash.

Oftentimes, the sensation of heat and sweating may be followed by a feeling of being chilled. The flashes usually last for a few minutes. They can occur frequently-even hourly-and can range in severity from mild to intense. And they can often interrupt sleep-many menopausal women talk about awakening suddenly, drenched in perspiration (these types of hot flashes are called night sweats).

Most naturally menopausal women start having hot flashes about 2 years before their last period occurs. The frequency of these episodes diminishes over time as they move into menopause, although they can continue for months or even years. In contrast, women who are taking tamoxifen for breast cancer may find that hot flashes increase in frequency and intensity over the first 2 or 3 months of treatment, start to stabilize, and then lessen.

Why Do Hot Flashes Occur?

It's not known exactly why hot flashes occur, but it's believed they have something to do with the body having trouble regulating its temperature. This may be due to a decrease in levels of the female hormone estrogen (estrogen production decreases after menopause and with breast cancer treatments) or other chemical triggers. It is thought that small temperature increases fool the brain into thinking the body is getting too warm and trip its cooling mechanism (the thermoregulatory system), resulting in a hot flash, with its attendant sweating and shivering.

Treatments and Remedies

In the past, women were told to just ignore hot flashes, suffer through them-or even that they were just a figment of their imagination. Past generations of women may have suffered hot flashes in silence, having been taught not to talk about them, or about any reproductive matters or bodily functions.

Today, though, we know for sure that hot flashes exist-and that they affect many women. Ask your doctor if any of your medications may be causing your symptoms. If so, changing medications may be helpful. If not, current treatments for hot flashes are far better than they used to be.

Here's a rundown of some of the most effective therapies . . . .

Estrogen
Pros: This hormone is the best treatment for hot flashes and can reduce their intensity and frequency by 70% to 90%. Estrogen replacement therapy (ERT) also helps to reduce the risk of osteoporosis (bone thinning), and prevents thinning and dryness of the vagina.

Cons: If a woman with a uterus uses estrogen without also taking a progestin (another female hormone), she has an increased risk of developing cancer of the uterine lining (the endometrium). It may also increase the risk of developing breast cancer, and estrogen can't be used by women with breast or uterine cancer because it might make the condition worse. ERT may also cause side effects like stomach upset, breast tenderness, headache, mood changes, fluid retention, and blood clots.

Progestin
(also called progestogen or progesterone)
Pros: This female hormone is often given to women with a uterus who are taking ERT because it prevents uterine cancer. But whether taken together with ERT or alone, it helps to stop hot flashes. Taken by itself, it reduces the incidence of hot flashes by about 85%.

Cons: It's not entirely clear if it's safe for women with breast cancer to use progestins to treat hot flashes. Studies are being done to determine if the hormone spurs the development or recurrence of cancer. Use of progestins can also bring back menstrual periods, which many women dislike, as well as cause breast tenderness, mood changes, and stomach bloating.

Androgen
Pros: Women normally produce this male sex hormone, androgen (also called testosterone) in small amounts. At menopause, production decreases. Studies suggest that in combination with estrogen, androgen may reduce hot flash frequency. It also has the added benefit of enhancing sexual functioning and the desire for sex.

Cons: Androgen can have a number of unwanted side effects. It can cause acne, hair growth on the face, lowering of the voice, and can alter cholesterol levels in an undesirable manner. However, when used with estrogen it can be given in smaller doses that are less likely to cause these side effects.

Clonidine
Pros: This drug, which is approved by the Food and Drug Administration (FDA) for reducing high blood pressure, has been studied as a treatment for hot flashes for 20 years and found to reduce them by 37% to 46%. (JNCI) The primary advantage of clonidine is that it is not a hormonal treatment, so women who can't take hormones-including breast cancer survivors-may be able to use it.

Cons: Clonidine has a number of side effects. It can cause mouth dryness, constipation, and sleepiness.

Alternative Therapies

Because some women can't or don't wish to take hormonal drugs such as estrogen or progestin to treat hot flashes, a number of alternative therapies have become available. Most have not been all that well tested and don't appear to work as well as ERT or other drugs. If you decide to try any of these products, be sure to tell your doctor first to make sure it won't interact with your medications or breast cancer treatment.

Soy. This plant protein is believed to have estrogen-like effects, and one study found it reduces hot flashes by 45%. Soy products may be fine for healthy women to consume for up to 2 years to treat hot flashes. However, the American College of Obstetricians and Gynecologists says that because soy may interact with estrogen receptors, the products may not be safe for women with estrogen-dependent breast cancers.

Vitamin E. Although this fat-soluble vitamin has been touted as a hot flash remedy, a study comparing it to a placebo found that it didn't reduce hot flashes very much in women with breast cancer.

Black cohosh. This herb is a traditional remedy used by American Indians and in Europe to treat menopause symptoms. Limited studies suggest that it is safe and somewhat effective in relieving hot flashes, although it may not work well if you're taking tamoxifen. If you decide to try black cohosh--which as an herb is not regulated by the FDA--look for a product that has the insignia of the U.S. Pharmacopeia (USP) or the National Formulary on it. These labels indicate that the products meet certain quality standards.

Treatments in the Pipeline

Several drugs are being tested as potential treatments for hot flashes. For instance, medications that are approved by the FDA to treat depression also appear to be able to relieve hot flashes in about 60% of breast cancer survivors and other women with postmenopausal symptoms. (Loprinzi et al)

Likewise, a drug that is used as a birth control agent also appears to have the side benefit of reducing hot flashes in women with a history of breast cancer.

Turning Down the Heat

In addition to drug treatments-or even instead of-try the following strategies courtesy of the American College of Obstetricians and Gynecolo-gists to manage hot flashes naturally.

• Wear loose clothing so your skin can breathe. Also wear layers, so you can take some clothing off during a hot flash.
• Wear fabrics, such as 100% cotton, that absorb perspiration and dry quickly.
• Avoid foods and beverages-such as hot coffee or tea, spicy foods, and alcohol-that you find trigger flashes.
• Splash your face with cold water or take a cold shower when you get a flash, or drink an ice-cold beverage.
• Avoid stress, which can make flashes worse. Meditate, or do deep breathing or visualization exercises when you feel a hot flash coming on.
• Exercise daily. It may help reduce hot flashes.
• Set your thermostat to less than 70 degrees during the day and less than 65 degrees at night.

Young Survival Coalition
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www.youngsurvival.org