Help for Breast Cancer Treatment-Related Hot Flashes

Are hot flashes a problem for you?

We all know that hot flashes often accompany natural menopause. Many of us have learned that hot flashes also accompany an early, abrupt menopause brought on by cancer treatment, either  surgery to remove the ovaries or chemotherapy or hormonal therapies or a combination. Even some women who have already experienced natural menopause have another round of hot flashes when hormonal treatments (aromatase inhibitors) are prescribed for breast cancer.

My non-physician observation has been that cancer treatment-related menopause is often more intense than its natural cousin. Instead of the symptoms appearing gradually over time, they begin all at once, either right after surgery or upon the initiation of chemotherapy or hormonal therapies. I picture the symptoms being crushed together, becoming stronger and more frequent.

Everyone is different, and some women experience mere warm flashes while others are tormented by intense variants. Some women describe feeling as though they are on fire when their face turns bright scarlet and sweat rolls down their cheeks. Sometimes the flashes seem to occur randomly while other times they are brought on by stress or anxiety, spicy foods, caffeine or alcohol. Other triggers can be any situation that raises your body temperature: hot baths or showers, hot tubs, hot rooms or hot, humid weather. The symptoms can happen any time of day or night, but may be especially troublesome at night. Some women are awakened multiple times, drenched in sweat, and are chronically exhausted.

The two basic approaches to managing hot flashes are behavioral and medicinal. Behavioral possibilities begin with paying careful attention to your own life and hot flash patterns. Have you observed particular situations or times of day/night when you are most likely to experience them? The first life style intervention that is usually recommended is exercise. We already know that regular mild to moderate exercise will help with other issues: weight management, stress control, bone density and energy. Here are a number of other practical suggestions that may help.

• Keep ice water with you and a thermos by your bed at night
• Keep a few wet washcloths in the freezer during the day. At night, move them to a small cooler by your bed. The frozen cloth will feel wonderful when you are boiling hot.
• Avoid synthetic fibers day and night, including sheets.
• Keep a few extra pillows handy, so you can switch to a cool one as needed.
• Keep a few paper fans in your office or home and be prepared to fan your hot face in a lovely old-fashioned, glamorous way.
• Always dress in layers that can be easily shed.

At the San Antonio Breast Cancer meetings in December 2018, a study was presented that suggests that oxybutynin, a medicine commonly used to treat bladder incontinence, reduced the number and severity of hot flashes. The lead investigator, Dr. Roberto Leon-Ferre, said: “More important than just reducing the frequency and severity of hot flashes, what we saw in our study as well is that patients rated a significant improvement in the hot flash interference with daily activities. So we measured, for example, how did the hot flashes interfere with work, how did the hot flashes interfere with leisure activities, social activities, concentration, sexuality, and overall quality of life, and patients on oxybutynin reported an improvement in nearly all of those quality metrics with the exception of concentration and sexuality. All the others were improved.”  Read more about this study here.  

This drug joins several others that are sometimes helpful, including a low dose of a common antidepressant, Effexor. If it seems relevant, talk with your doctor about possible medications that might help you.

The good news here is that the hot flashes will eventually diminish and stop. No one can predict exactly when that happy time will come, but it will. Promise.