Managing Hot Flashes

Facts and Tips

Breast cancer treatments, both chemotherapy and hormonal therapies, can result in hot flashes. Chemotherapy can move a woman along into an early menopause, and hormonal therapies are designed to deplete estrogen. When newly diagnosed women begin to think about treatment and possible side effects, hot flashes are not often on their radar--until they begin.

My non-doctor experience has been that the frequency and intensity of hot flashes are variable, and women experience very different levels of this problem. When I underwent chemotherapy for my first breast cancer, I was 44, and went from having completely regular periods to menopause after one cycle. That was rather shocking, but I was relieved that the hot flashes were not a big issue. For me, they were more accurately described as warm flashes. I surely have known women, however, who suffered intense and debilitating and embarrassing hot flashes--turning scarlet and having sweat pour down their faces.

Here is the first thing to know: If you are wondering if you are having hot flashes, you aren't. The sensation is completely unique, and the first few times, you will wonder: What is that? and then Oh....

This may be harder to manage when it happens to younger women who have not really been thinking about menopause and probably don't have many friends who have been through it. Any life experience that happens in the company of our friends is easier as we feel understood and supported, and we share strategies. This is an excellent example of a moment when having cancer buddies can be helpful. 

Hot flashes happen because of increased sympathetic activity in the brain that is stimulated by a lack of estrogen. They often occur during sleep, awakening us to a drenched body and restlessness. Stress can trigger hot flashes, and this is sometimes the cause of embarrassing moments during an important meeting or presentation. Some people also find that spicy foods or hot beverages--coffee especially--can be triggers. Estrogen, of course, is the gold standard treatment, but there has been a lot of concern about hormone replacement therapy (HRT), and most women are strongly advised to avoid it post-breast cancer. Sometimes clonidine, one of the SSRIs, fluoxetine, or a few other medications may be helpful. Talk to you doctor if you are interested.

Behavioral measures help a lot of women, with exercise topping the list. Since stress is often a culprit, regular exercise may help with that, too. Other possibilities include learning relaxation techniques or meditation.

We can't stop hot flashes, but there are some useful measures to try:

1. Consider keeping a small, six pack-size cooler by your bed. During the day, put a couple of wet washcloths in the freezer and transfer them to the cooler when you go to bed.

2. Keep an extra pillowcase and nightgown or pajamas by your bed.

3. Try having a small fan nearby that can be aimed at your face. Remember that once the hot flash passes, you may be chilled and want to switch it right off.

4. Avoid synthetic bedding or nightclothes. Stick with cotton.

5. If you share your bed, consider not sharing all of your covers. Either use two sets of blankets or look for an electric blanket with dual controls.

Remember, like everything else, this, too will pass. Eventually.