Hot flushes and night sweats

Hot flushes are the most commonly reported menopausal symptom caused by breast cancer treatments such as tamoxifen.

Hot flushes can be caused by several treatments including chemotherapy, hormone therapy or ovarian suppression.

A hot flush can range from a mild sensation of warming which just affects the face, to waves of heat throughout the body. Some women also experience a drenching sweat affecting the entire body.  

The frequency of hot flushes can vary for each person, from a couple a day to a few every hour.

Many women also get flushes at night, which can lead to disturbed sleep and waking in a cold, damp bed and needing to change the bed linen. This can be very disruptive, especially if you share a bed.

Disturbed sleep because of hot flushes can mean being forgetful, feeling irritable and having difficulty concentrating.

For some, hot flushes will fade over time and become less severe, but for others they can last for many years.

1. Keep a battery-operated or paper fan with you at all times
2. Wear layers so that you can remove clothing when a flush starts
3. Wear loose-fitting, cotton clothing
4. Use a silk pillowcase, a specially designed pillow that stays cool or a cooling scarf
5. Always keep a bottle of water with you
6. Avoid caffeine, alcohol and spicy foods
7. Carry a water spray to use on your face or wrists to cool you down

Non-hormonal prescription drugs for hot flushes

A number of prescription drugs have been shown to relieve hot flushes and some women find these helpful.

Some of these drugs may interact with other drugs you might be taking, so check this with your treatment team.

You may need to try several drugs before you find one that helps you.

Like any drugs these can have side effects so you may need to see if the benefits of taking them outweigh the drawbacks.

Antidepressants

Some antidepressant drugs can help reduce hot flushes for some women, although these benefits may wear off over time.

Antidepressants can be prescribed in a lower dose to help with hot flushes than when prescribed for depression, and so are unlikely to have an antidepressant effect.

Antidepressants that may be prescribed for hot flushes include:

• Venlafaxine
• Citalopram
• Escitalopram
• Fluoxetine
• Paroxetine

Side effects vary between drugs but can include:

• Nausea (feeling sick)
• Diarrhoea
• Sleepiness
• Loss of sex drive
• Dizziness

Taking antidepressants to help with hot flushes can take a few weeks to have an effect.

Gabapentin and pregabalin

Gabapentin and pregabalin are drugs usually used to treat chronic pain and epilepsy but they may also be helpful in reducing hot flushes.

They can have side effects, including:

• Fatigue
• Sleep disturbance
• Anxiety

Taking them at night and slowly increasing the dosage over time may reduce the side effects.

Clonidine

Clonidine is normally used to treat high blood pressure. It can also be used for managing hot flushes, and may be effective for some women.

Side effects include:

• Light-headedness
• Dry mouth
• Headaches
• Constipation
• Drowsiness

Clonidine can take a few weeks to work.

Hormone replacement therapy (HRT)

Although HRT is an effective treatment for menopausal symptoms, it’s not usually recommended for women who have had a diagnosis of breast cancer. This is because there’s uncertainty about whether HRT increases the risk of breast cancer coming back.

However, it may be recommended if you experience severe menopausal symptoms that significantly affect your quality of life, and if you haven’t responded to other treatments.

Your treatment team will discuss the risks and benefits of HRT and whether it may be appropriate for you.

Cognitive behavioural therapy (CBT)

Some studies have shown that a type of talking therapy called cognitive behavioural therapy (CBT) may help with menopausal symptoms, including hot flushes and night sweats, as well as low mood.

Your treatment team or GP may be able to let you know how to get CBT locally. You can also download various apps to practise CBT yourself.

Complementary therapies include a wide range of approaches that some women find helpful in relieving menopausal symptoms or improving their sense of wellbeing.

Compared to conventional drug treatments there is much less reliable evidence to show that complementary therapies work.

It’s also important to consider the safety of some therapies, including whether any interact with the treatment you are having.

Tell your treatment team about any complementary therapy or herbal supplement that you are considering using.

Complementary therapies include:

1. Hypnotherapy
2. Acupuncture
3. Herbal remedies
4. Phytoestrogens
5. Aromatherapy
6. Homeopathy
7. Massage
8. Reflexology

Manufacturers of a magnet that is attached to the underwear suggest it can help reduce hot flushes and other menopausal symptoms. There is no evidence that these magnets work, but some women say they have found them useful.

For more information see menopausal symptoms and breast cancer. 

You can visit our confidential online forum and join one of the ongoing discussions about hot flushes.