One of the most common concerns among breast cancer patients is how to deal with hot flashes. They are a huge problem that affects the quality of life for over half of women treated with endocrine treatments. In fact, hot flashes are the number one reason they think about stopping treatment. HRT is very effective but it can almost never be used due to risk. So I want to share some of the alternative treatments to HRT for you to discuss with your doctors. There are also many women who don’t have breast cancer who either can’t or don’t want to take HRT for the low estrogen symptom of hot flashes. This will help you as well.
Here are options I discuss with my patients to help them turn down the heat:
One simple thing is to ask your doctor to check your vitamin D level (get a 25-OH vitamin D). Low levels are very common and if yours is low, it can increase your risk for heart disease, breast cancer, brittle bones and increase hot flashes. Getting vitamin D levels back to normal often reduces hot flashes and you’ll feel much better. It’s simple; just take a vitamin D3 supplement. It usually takes three months. There are videos about this and related topics at http://www.doctorseibel.com/menopause/.
Lifestyle non HRT approaches include:
- Drink plenty of water daily (8 glasses or more)
- Daily exercise (walking 30 minutes is great)
- Yoga classes (I like Kundalini Yoga best and I discuss the many benefits in A Woman’s Book of Yoga)
- Meditate daily – even 1 to 5 minutes at first and work your way up to longer. Keeping the mind calm and silent works wonders.
Mindfulness-Based Stress Reduction is another great non HRT way to reduce hot flashes. It’s an approach introduced by Jon Kabat-Zinn and involves daily mindfulness exercises.
- Acupuncture – one study obtained a 60% improvement.
- Avoid caffeine, spicy foods and alcohol
- Carry a cool wipe to remove the sweat. It’s very cooling.
Herbal approaches include:
- Black cohosh (20 mg twice daily)
- Soy (50 to 100 mg of the soy isoflavones in a capsule or 25 to 40 grams of the protein in a smoothie or added to your food)
- iCool is a non-soy isoflavone if you’re allergic to soy
- Flaxseed, another plant estrogen, 1-3 tablespoons on cereal in the morning
Non HRT prescription meds such as:
- SSRI antidepressants [there is evidence showing that paroxetine (Paxil, Paxil CR), escitalopram (Lexapro) and fluoxetine (Prozac) can be effective in controlling hot flashes] and SNRI antidepressants such as venlafaxine (Effexor) have been used widely for hot flashes. A recent study suggests that adding zolpidem (Ambien, Edluar, Zolpimist) to these medications may be helpful for improving sleep but not hot flashes.
- Neurontin (gabapentin) the anti-seizure medication. Start low and increase dose slowly up to 900 mg daily. It causes drowsiness in some women.
- Clonidine (Catapres) acts on the brain to lower blood pressure and it helps some women (but not all) reduce hot flashes. It can cause dry mouth and constipation.
There are many alternative options in my book The Soy Solution for Menopause from Simon & Schuster.
Women who are thinner have less hot flashes than women who weigh more.
I’ve used all of these approaches to help patients with hot flashes who either cannot or do not want to take HRT and have low estrogen. Talk with your health care provider and ask him or her to work with you to find what works best for you. With persistence and patience, most women find a combination that works for them.
Machelle (Mache) Seibel, MD is one of America’s top health communicators. Whether speaking, consulting, writing or composing he teaches people the health information they need and the perspective they require to stay well. His passion is to help America stay well. “It’s better to stay well than to get well.” Professor and Director, Complicated Menopause Program, University of Massachusetts Medical School 2004-Present Founder of HealthRock®, reshaping health education with music and entertainment Harvard Medical School faculty nearly two decades Past Medical Director, Inverness Medical Innovations (now Alere) 2008 Recipient, Ashbel Smith Distinguished Alumnus Award, the University of Texas Medical Branch’s highest honor Multiple national awards for research, writing, music and patient education received Author/editor 14 books, over 200 scientific articles, past editor-in-chief of the medical journal Sexuality, Reproduction & Menopause Advisory board of Dr. Mehmet Oz’s HealthCorps initiative to fight childh