Hot Flushes


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Hot flushes are described a sudden unpleasant sensation of burning heat spreading across the face, neck and chest, can occur. Shortly after the sweat patients can then feel cold and clammy and even shiver. Some patients experience one or two flushes a week, whilst others can have ten or more a day but generally, the number of hot flushes will decrease over time.

Night sweats are described as a sudden sweat often linked to hot flushes and tend to happen at night. Patients sometimes find that their sleep patterns are disturbed because of these sweats. Research published form our team has shown that trying different hormone drugs many help or if this fails limited success has been gained from some prescribed drugs including; progesterone, clonidine or antidepressants. All these drugs of course have side effects of their own so lifestyle strategies are certainly worth a try first. 

Causes - All women will naturally go through the menopause usually between 50-55 years of age. Some lucky women have very few effects but in other they suffer considerable hot flushes and night sweats. Some cancer treatments interfere with the function of the ovaries in women or testes in men. This often causes hot flushes which may be permanent or temporary. The risk of this should have been discussed before the start of therapy. The ovaries and testes have two main functions; to produce eggs and sperm and to produce sex hormones (testosterone in men & oestrogen and progesterone in women). In pre-menopausal women the 3 main causes ovarian failure which can cause menopausal hot flushes are:

Other drugs can cause hot flushes without necessarily affecting ovarian failure. These include hormone therapy such as

Non hormonal drugs can also cause or increase the severity of hot flushes ven less obvious causes such as some bone hardening drugs. such as the bisphosphonates

 What can you do to help?

Many people practice self-help techniques that can assist in making hot flushes less uncomfortable. You may find it useful to keep a note of when you have hot flushes so that you can identify any pattern. If you know when to expect hot flushes you can be better prepared. Otherwise here are some practical tips which may help:

Clothes, environment and hot flushes:

  • Wear cotton clothing rather than polyester or other man made fibres, as cotton absorbs moisture and still provides warmth after a flush is over

  • Try wearing layers of clothing that can be taken off or put on as your body temperature changes

  • Use several layers of bedclothes (natural fabrics are better) which you can remove as required

  • Try using sprays or moist wipes to help lower your skin temperature (you could add pleasant smelling oils to the spray, such as peppermint which has cooling properties or lavender which has a relaxing effect.

  • Use an electric fan placed on a desk or table to help lower your skin temperature

  • If you are not sleeping well because of flushes, try to find time to have a rest during the day

  • Try to avoid warm, stuffy rooms as they can make flushes worse

  • Take plenty of cool baths and showers

Diet & hot flushes:

  • Avoid spicy foods, especially at night

  • Avoid large meals and excess sugar

  • Hot drinks can trigger a hot flush open a window and take your coat or scarf off first

  • Being over weight can be more difficult to regulate body temperature if so, try to lose some weight

  • Avoid stimulants such as caffeine

  • Drink plenty of healthy fluids, particularly if you are sweating a lot

  • Avoid too much alcohol which can aggravate hot flushes, particularly wine (chianti) and cherrybrandy

  • Soya foods and other phyto-oestrogens these are chemicals which are found in plants. They are similar in structure to the female sex hormone oestrogen. They are found in soya bean products, others are found in the fibre of whole grains, fruit, vegetables and flax seed. Milk may also contain Phyto-oestrogens, but this depends on what the cows have been eating! Women whose diets are high in Phyto-oestrogens have a lower risk of hot flushes. In some studies eating phyto-oestrogens (soya flour and linseed supplements) regularly over several weeks reduced the individuals own oestrogen levels despite the higher levels of the plant oestrogen. Unfortunately, the only well conducted trials of phyto-oestrogens in breast cancer patients with hot flushes have recorded very little benefit. Of more concern is that many oncologists around the world are not comfortable to recommend supplements of phtyo-oestrogens as, at this concentration, they may stimulate any residual cancer cells encouraging them to grow and spread There is no evidence for this either but the most common sense stance would be to try foods with plant oestrogens as they are generally health and also packed with other health components such as anti-oxidants, fibre and vitamins but avoid supplements unless further evidence of a benefit ensues.

  • Evening primrose oil  Many people have found that taking evening primrose oil helps with hot flushes, although it may take several months before any improvement is noticed. Evidence from clinical trials is lacking but apart from the calories it is regarded as generally safe. You can buy evening primrose oil in chemists and health food shops.

  • Vitamin and mineral supplements Vitamin E, selenium and vitamin B6 have provided relief for some people. Again evidence is lacking but provided you check with your GP or cancer specialist before you start taking any vitamins or minerals and never take more than the recommended dose they are probably not harmful.

Smoking & hot flushes:

  • Smokers suffer worse hot flushes around and after the menopause

  • Smokers are at higher risk of osteoporosis

  • It is strongly advised to give up altogether

Relaxation techniques:

Stress can increase the number and intensity of hot flushes a person has. Being anxious about hot flushes could make your symptoms worse. Knowing what to expect and being prepared will help you feel more in control and ease your anxiety. Relaxation therapy can reduce stress and flushes. Hot flushes usually come and go over short periods, so try to relax and wait for the sensation to pass. You may find it helps to imagine yourself in a cool place, for example by the sea, when you feel a hot flush coming on. It may also help to know that although hot flushes are uncomfortable for you, other people are unlikely to notice them happening. (For information on training courses and resources, contact the Stress Management Training Institute. There is also a wide range of relaxation tapes available from health food shops and bookshops).  

Weight control

Exercise & hot flushes

Regular gentle exercise may help reduce hot flushes. Choose an activity that you enjoy and feel comfortable with. (see exercise section on how to exercise after cancer)

Medical interventions

These are listed after lifestyle strategies on this page as it is always worth trying non-drug therapies first as drugs can have risks and side effects of their own. Nevertheless, if hot flushes persist and are affecting your quality of life then it will be worth discussing drugs with your general practitioner / oncologist

Change current medication. If you are post menopausal and are taking tamoxifen for breast cancer it may be worth discussing changing to an aromatase inhibitor such as anastrozole. Although these can also cause hot flushes and have other side effects a recent study showed they are, in general, not as severe. (read full paper by Thomas et al). In any case if after trying AI's  for 6-8week you can then be in a position to choose which one suits you best. If you are already taking an aromatase inhibitor and still have troublesome hot flushes you may wish to discuss with your doctor switching to a different brand. There was a piblished trial which showed that a significant proportion of women had a different group of symptoms after they tried switching (read full paper by Thomas and Makris et al)

  • Clonidine
  • Venlaflexine
  • Progesterone

Complimentary therapies & hot flushes

Many patients use a range of complementary therapies, such as acupuncture, reflexology, chiropractic measures, massage and meditation. Strong evidence for these has not been published but there are a number of interesting anecdotal reports of success. If you want to try a complementary approach it is best to go to a recognised, qualified practitioner.

Homeopathic remedies: Homeopathic remedies recommended for hot flushes include sage, pulsatilla, rhubarb, root extract, sulpha and graphites. A qualified homeopath will prescribe the remedies that are best for you.

Aromatherapy: Some patients find that aromatherapy massage with essential oils such as clary sage and chamomile improves symptoms.

Herbal remedies: Ginseng, black cogosh, dong quai, lavender, fennel, false unicorn toot and wild yam are all herbal or plant remedies that have been used to relieve menopausal symptoms. Some of these herbal remedies help because they have phytoestrogenic properties so it is important to discuss with your cancer specialist first. Most herbalists will tell you that sage is a natural anhidrotic (reduces sweating) and can help excess sweating during the hot flush.

Massage, & reflexology: Are perfectly safe. There is absolutely no evidence that they can push cancer cells around the body as is commonly quoted in folk law. Although evidence of benefit is lacking they are enjoyable and relaxing.

Acupuncture: The are now some good randomised trials showing a good benefit from acupuncture. Certainly acupuncture has been found to be as good as anti-depressants such as venlaflexaine

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