Hot Flashes

What are hot flashes?
Who gets hot flashes?
What are the symptoms of hot flashes?
What are some symptoms that women have?
What are some symptoms that men have?
How long will I have hot flashes?
What causes hot flashes?
What makes hot flashes worse?
How are hot flashes diagnosed?
How are hot flashes treated?
How can I manage my hot flashes?
What other health problems are related to hormonal cancer treatments?
References
Hot Flash Diary

What are hot flashes?
Hot flashes are feelings of intense warmth. Reddening or flushing of the skin, sweating, and an increased heart rate may accompany these feelings. Hot flash symptoms range from mild to severe and may also come with:

  • Anxiety;
  • Sleep disturbances;
  • Mood changes and irritability;
  • Feeling out of control.

Who gets hot flashes?
Both men and women can have hot flashes.

About 85% of all women will have hot flashes at some point in their lives. The severity of the hot flash varies widely from one woman to another. These flashes can be especially severe in women who have undergone surgery, chemotherapy, or radiation therapy that has caused an end to the monthly menstrual cycle or “period”. Hot flashes can even begin again in older women who have gone through menopause at an earlier age.

While hot flashes are mainly seen as women’s symptoms, they can also affect men on hormone treatments for prostate cancer. Stopping the production of testosterone and blocking the effect of testosterone on the prostate are two of the ways that prostate cancer is treated. Almost 75% of men on these treatments have hot flashes. Many men are not willing to talk about hot flashes. Just as in women, hot flashes can also disrupt their quality of life.

What are the symptoms of hot flashes?
Hot flashes appear suddenly and without warning. They generally last a few minutes. For most people, hot flashes do not disrupt their lives because they are mild and are not frequent.
For others, however, hot flashes are more disturbing. People being treated for breast or prostate cancer may have longer lasting and more intense hot flashes. While the hot flash may last a few minutes it can take up to one half hour to feel “normal”.

The most common times for hot flashes to happen are during the early morning and the evening. Sometimes, hot flashes can make you lose sleep. Chronic sleep loss may lead to mood changes, irritability, and difficulties in relationships with family and friends. Talk to your physician or nurse if hot flashes upsets your sleep.

Both men and women may have similar symptoms such as:

  • Redness and warmth on the skin of the scalp, face, neck, shoulders and upper chest;
  • Pounding heartbeat;
  • Sweating (mild to heavy) of the scalp, face, neck, and chest, followed by a feeling of deep unpleasant chilling;
  • Sometimes an odor may be present.

What are some symptoms that woman have?

  • Irregularity or stopping of menstrual periods;
  • Vaginal dryness caused by thinning of the lining of the vagina and decreases in the production of vaginal secretions;
  • Painful intercourse;
  • Decreased interest in sex;
  • Urinary changes such as the need to urinate more often even when the bladder isn’t full.

What are some symptoms that men have?

  • The inability to have or sustain an erection;
  • Hot flashes in men may last much longer than in women.

How long will I have hot flashes?
The strength of hot flashes may become less after the first three to six months of treatment. But, for some women and men severe hot flashes will continue for the entire time that they are on hormonal therapy. Once the therapy is stopped hot flashes will decrease.

What causes hot flashes?
No one knows for certain what causes hot flashes. The likely cause is a decrease in a hormone called estrogen. Both men and women produce estrogen. Estrogen affects the part of the brain that controls the body’s temperature. Many cancer treatments cause a decrease in estrogen levels.

This decrease in estrogen directly affects the hypothalamus (HI-POH-THAH-LA-MUS) . This part of the brain controls things like appetite, sleep cycles, and body temperature. When there is a decrease in estrogen, it seems like the brain “thinks” the body is too hot. The hypo¬thal¬amus then produces chemicals to help correct this false body temperature. As a result, the body begins a process to cool itself. The heart beats faster, the blood vessels in the skin enlarge to let heat escape, and sweat is produced to cool the skin.

This process is uncomfortable. The skin temperature can rise by six degrees centigrade (6°C) and then suddenly cool as sweating occurs. In the space of a few minutes the body can become flushed, perspire and become soaking wet. The chilling sensation after a hot flash is just as disturbing. Sometimes it may be felt as deep internal chilling with shivering.

What makes hot flashes worse?
Smoking causes the blood vessels to lose some of their ability to release heat. This may cause more severe hot flashes.

Hot drinks, caffeine, stress, spicy food, and alcohol can trigger hot flashes and make them stronger.

How are hot flashes diagnosed?
There are no tests to diagnose hot flashes or to measure their severity.

Keeping a hot flash diary is the best way to find out the frequency and severity of hot flashes. This information helps your doctor or nurse practitioner choose the best method of treatment and will also help in measuring how well the treatment works.

How are hot flashes treated?
Treatment starts by identifying the triggers for hot flashes. Common triggers include:

  • Stress
  • Hot tubs, saunas, and hot showers
    Alcohol
  • Hot beds, flannel pyjamas and sheets
    Caffeine
  • Hot drinks
    Spicy food
  • Hot weather
    Smoking


Hot flashes are divided into mild, moderate, and severe. Only you can decide the severity of your hot flashes. The reason is that hot flashes cannot be compared from one person to the next. Keep a record for one week of when they occur, what you were doing, and how long they lasted (see the Hot Flash Diary).

How can I manage my hot flashes?
Simple lifestyle changes without medication may be all that is needed. Some of these changes may include:

  • Dress in layers, so clothing can be removed one layer after another;
  • Avoid wool, synthetic, and silk clothing. Better choices include cotton, linen, and rayon;
  • Avoid turtlenecks. Wear open-neck shirts, sleeveless tops that can be layered with a jacket or loose top;
  • Keep ice water nearby to sip as needed and cool the body inside;
  • Lower the thermostat when possible (provide other household members with a sweater);
  • Wear cotton pyjamas or a nightgown. If perspiration at night is a problem, nightclothes are easier to change than sheets;
  • Use cotton sheets and avoiding synthetic or flannelette. A bigger bed may help if your partner is warming your side as well;
  • Take a cool shower before bed.
  • Choose the coolest places to sit in meetings, theatres, etc. Try sitting near air vents, doors, and at the ends of rows;
  • Maintain a healthy weight or lose weight if heavy;
  • Exercise! Besides reducing hot flashes, there are added benefits. A recent study of breast cancer patients has shown that exercising for thirty minutes, three times a week reduces the risk of breast cancer from coming back.
  • Quit smoking and use less caffeine.

Frequent and severe hot flashes may require a different approach. For women, hormone replacement therapy (HRT) reduces hot flashes. Unfortunately results from several large studies have shown that HRT is not recommended for women who have had breast cancer.

There are other medications that have shown to be of benefit and the London Regional Cancer Program participates in studies on treating hot flashes. Talk to your doctor, nurse practitioner or primary nurse about these treatment options.

You can also ask for a referral to the Hot Flash Clinic at the cancer centre.

What other health problems are related to hormonal cancer treatments?
Long-term hormonal therapy can have an effect on your bones and heart. Your doctor will talk with you about this before starting hormonal treatment.

Aging normally causes a loss of bone mass. But for men and women on hormone treatments for cancer, there is an increased risk for osteoporosis.

Osteoporosis is a condition where bones are weaker, making them more likely to break. It is a “silent” condition that can go unnoticed until a bone breaks. Any bone can be affected. Broken bones most often occur in the hip, spine, and wrist. Talk to your doctor or nurse practitioner about whether you need to take extra calcium and vitamin D.

Women have a lower risk of developing heart disease due to the protective effect of estrogen. Ten years after menopause this risk becomes equal to men. Both women and men can reduce their risk of heart disease by maintaining a healthy weight, controlling their blood pressure, and controlling blood sugar.

References

Boekhout, A., Beijnen, J., and Schellens, J. (2006). Symptoms and treatment in cancer therapy induced early menopause. The Oncologist, 11: 641-654

Crandall, C., Peterson, L., Ganz,P., and Greendale, G. (2004). Association of breast cancer and its therapy with menopause-related symptoms. Menopause, 11(5): 519-530

Nelson, H.D., Vesco, K.., Haney, E., Fu, R., Nedrow, A., Miller, J., Nicolaidis, C., Walker, M., and Humphrey, L. (2006). Nonhormonal therapies for menopausal hot flashes: systematic review and meta-analysis. Journal of the American Medical Association, 295(17): 2057-2071.

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Last Updated July 16, 2008 | © 2007, LHSC, London Ontario Canada