Reducing hot flashes for ER-positives?


Question from Helanna: Is there an effective remedy for estrogen-receptor-positive breast cancer patients who are experiencing hot flashes? My oncologist wanted me to take Clonidine, but my last blood pressure check at the time of chemo was 80/55, and I was afraid to take medication that might reduce my already low blood pressure.
Answers - Julie Gralow, M.D. Obviously, managing menopause without hormones is a topic of great interest to breast cancer survivors. Interestingly, even in estrogen-receptor-negative breast cancers, we tend to avoid prescribing estrogen for hot flashes, because a woman who has had one breast cancer is at higher than average risk for a second breast cancer and estrogen is associated with some increase in breast cancer risk. With respect to things that can help with hot flashes without using estrogen, 10 years ago the two best prescription treatments were probably Clonidine and Bellergal. Both have some benefit in helping with hot flashes, but generally cause their own side effects, which can be as bad as or worse than the hot flashes. You're absolutely right in being concerned about using Clonidine, which is an anti-hypertensive, if you already have a low blood pressure.

Over the last several years, we've had some very nice scientific studies evaluating newer agents that have fewer side effects, and, in many cases, offer more benefit in treating hot flashes. A class of antidepressant drugs, of which Effexor may be one of the most commonly used, has been shown to help a lot of women with hot flashes. Recently, the Mayo Clinic group has shown that a drug called Neurontin, which is used mostly to treat seizures, can, at low doses, also help hot flashes. It may be used with or instead of Effexor. Some people find benefit from taking 400 IU of Vitamin E at night.

Other things you can do, short of taking prescription medications, would be to limit your caffeine and alcohol intake, since both can increase hot flashes. Smoking and nicotine, being stimulants, can increase hot flashes as well. In terms of reducing hot flashes, exercise can help; so can the mindful measures and therapies that Marisa has just gone over. Also, do common-sense things like dressing in layers, so if you feel a hot flash coming on, you can kick off your shoes or take off your sweater.
Marisa Weiss, M.D. Clearly, stress also contributes to hot flashes. Even if you can't experience things in a less stressful manner, sometimes just cutting out the non-urgent things in your life can make a difference. NOT rushing to a meeting can be helpful. You would be surprised how many things you treat as urgent can be handled in a different way. Not everything is an emergency. Our patients often tell us that getting breast cancer makes them reorder their priorities. Things that were not so important before become more important, and things that seemed very important before can become less important.

On Wednesday, January 15, 2003, our Ask-the-Expert Online Conference was called Managing Treatment Side Effects. Julie Gralow, M.D. and Marisa Weiss, M.D. answered your questions about many of the short-term and long-term side effects of breast cancer treatment, and ways of minimizing them, so you can get on with your life and enjoy your day-to-day activities.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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