Breast cancer is the most common cancer in women. The good news is that survival rates are increasing. But hot flashes are a real problem. So much so that 53 percent of women with breast cancer who receive hormone therapies have really bad hot flashes, which is the primary reason they consider stopping treatment. Hormone replacement therapy works great but it’s almost never allowed 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 without 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 some suggestions I make to my patients to help 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. I have found many women have fewer hot flashes and feel much better correcting their vitamin D level. It’s simple; just take a vitamin D3 supplement. Also, women who are thinner have fewer hot flashes than women who weigh more. There are videos about this and related topics at doctorseibel.com.
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 percent improvement.
- Avoid caffeine, spicy foods and alcohol
- Carry a cool wipe
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.
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.