Treatment Options for Hot Flushes
For the treatment of hot flushes, first-line therapy should include non-hormonal medications such as SNRIs, SSRIs, gabapentin, along with lifestyle and environmental modifications to help mitigate vasomotor symptoms. 1
Non-Pharmacological Interventions
Lifestyle Modifications
- Weight management is recommended as a first-line approach, as women who lose ≥10% of their body weight are more likely to eliminate hot flash symptoms compared to those who maintain their weight 2, 3
- Smoking cessation significantly improves both frequency and severity of hot flushes 2, 3
- Limiting alcohol intake is recommended if it triggers hot flushes in a particular individual 2, 4
- Avoiding triggers such as spicy foods, caffeine, and hot drinks can help reduce hot flushes 1, 2, 4
Environmental Modifications
- Maintaining cool room temperatures and dressing in layers to allow for quick cooling 1, 2
- Using fans, cooling pillows, and breathable clothing materials 1, 3
Mind-Body Approaches
- Acupuncture has been shown to be safe and effective for managing vasomotor symptoms, with some research finding it equivalent to or better than pharmacological treatments like venlafaxine or gabapentin 1, 2, 3
- Cognitive Behavioral Therapy (CBT) reduces the perceived burden of hot flushes and significantly improves hot flash problem ratings 2, 3
- Yoga may improve quality of life associated with menopause, including improvements in vasomotor symptoms 2, 3
- Rhythmic breathing techniques may help decrease the intensity of hot flushes 1
Pharmacological Management
Non-Hormonal Medications
SNRIs and SSRIs are first-line pharmacological options for hot flushes 1
- Venlafaxine (SNRI) has been found to be safe and effective in reducing hot flushes 1
- Low-dose paroxetine (SSRI) reduces the frequency and severity of hot flushes 1
- Important caution: Pure SSRIs, particularly paroxetine, should be used with caution in women taking tamoxifen due to potential inhibition of CYP2D6, which may reduce conversion of tamoxifen to active metabolites 1
- Doses required for hot flush management are typically lower than those needed for depression 1
Gabapentin (anticonvulsant) is effective in reducing hot flushes 1
Clonidine (antihypertensive) can be used in clinical practice for hot flush management 1
- May help decrease the intensity and severity of menopausal symptoms 1
Hormonal Therapy
- Systemic hormone replacement therapy (HRT) is the most effective treatment for vasomotor symptoms but is rarely given to patients with breast cancer 1, 2, 3
- For women without contraindications, HRT remains highly effective but must be weighed against potential risks including increased risk of stroke, pulmonary embolism, and invasive breast cancer with estrogen plus progestin 2, 5
Special Considerations
Breast Cancer Survivors
- Non-hormonal options are strongly preferred for breast cancer survivors 1
- SNRIs, SSRIs (with caution regarding tamoxifen interactions), gabapentin, and lifestyle/environmental modifications are recommended 1
- Avoid SSRIs that strongly inhibit CYP2D6 (particularly paroxetine) in women taking tamoxifen 1
Complementary Approaches
- Evidence for phytoestrogens, botanicals, and dietary supplements is mixed or limited 3
- Vitamin E has shown only marginal improvement in vasomotor symptoms 3
- Black cohosh has limited data showing possible benefit in the general population but no benefit in breast cancer survivors 3
- Phytoestrogens are contraindicated in women with a history of breast cancer 6
Treatment Algorithm
First-line approach: Lifestyle and environmental modifications (weight loss if overweight, smoking cessation, alcohol limitation, avoiding triggers, dressing in layers) 2, 3
Add mind-body techniques for persistent symptoms: acupuncture, CBT, yoga 2, 3
Pharmacological options based on severity of symptoms:
Tapered discontinuation of SNRIs and SSRIs to minimize withdrawal symptoms when stopping treatment 1