Breast Cancer: Alternatives to HRT for Hot Flashes

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. Itís 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

Lifestyle non-HRT approaches include:

  • Drink plenty of water daily (8 glasses or more)
  • Daily exercise (walking 30 minutes is great)
  • Meditate daily Ė 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 Ė 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 youíre 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.

Iíve 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.

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Natural Relief for Hot Flashes
Are You Perimenopausal? 14 Signs


Winn Adams
Winn A5 years ago


Ingo Schreiner
Ingo Schreiner5 years ago


Rama H.
Rudy V5 years ago

Due to estrogen related breast cancer, my oncologist recommended Black Cohosh
as a safe herb for hot flashes. It definitely works for me : ).

Dheeraj R.
Dheeraj R.5 years ago

Harmone Replacement Therapy suit very few people. It is not good way to cure your problems so I recommended alternatives you mention above are good way to avoid HRT Breast Implants Orange County

Austin Smith
Austin Smith6 years ago

Presently breast cancer is very common among women.Thanks for nice clarification. I got this site really very useful. Thanks for such an amazing post.

Cosmetic Surgeon

Michaela S.
Past Member 6 years ago

My ovaries were destroyed when I had radiotherapy to my abdomen in 2007 at age 45 and my periods just stopped from one month to the next. In the beginning I had hot flashes at least every two hours day and night and they were quite uncomfortable, especially in the summer. I used to have a little fan with me then as well to blow cold air onto my face.

Now I still get the odd hot flash, funnily enough especially when hubby comes home from work and he had a stressful day but I am so used to them now, I know that when one comes on, it will also pass again. I refused any medication for them right from the start. I do take Vit D3 but only a small dose.

Soooo glad I can just walk past the 'feminine hygiene' aisle in the supermarket, knowing I never have to bother with all that stuff ever again. Really not concerned about a hot flash here and there.

Mache Seibel MD
Mache Seibel MD6 years ago

Hi Lynn C.
Thanks for clarifying that point. Flaxseed must be ground to be effective or else it just passes through the intestines undigested. Many of the flaxseed products sold today are already ground but if not, be sure to ground yours.

Mache Seibel MD
Mache Seibel MD6 years ago

One additional thought on black cohosh. It was initially thought that it worked like a plant estrogen. Newer studies have suggested it does not act like an estrogen. There are lots of related info on this an my website at You can also get a free eBook of HRT (hormone replacement therapy) there.
Mache Seibel, MD

Mache Seibel MD
Mache Seibel MD6 years ago

Hi Belinda,
My new cookbook, Eat to Defeat Menopause (on Amazon) talks about this a lot. A plant estrogen is not the same as prescription estrogens. They have a similar structure so a woman's cells allow them to attach to the cell's receptors. They differ from prescription estrogens by being much weaker and having only a fraction of the affect. In women with normal estrogen levels, the plant estrogens actually block the body's stronger estrogens from attaching to the cell's receptors. In women with low estrogen levels, they cause a weak estrogen-like response. There are hundreds of studies on this.

Mache Seibel MD
Mache Seibel MD6 years ago

Hi Jane B,
Testosterone can be very helpful for women with low testosterone. But for those with normal levels, adding testosterone can cause blood levels to rise abnormally high and can cause acne and facial hair growth, increased muscle mass and occasionally thinning of the hair on the scalp if levels remain too high. Also, testosterone is converted in the blood to estrogen. That said, testosterone can be a great choice for some women, though typically it is used for lower libido and not hot flashes. Be sure and discuss with your doctor first and have blood levels monitored.