Young women with
breast cancer often experience early menopause as a result of the
therapy for their malignant disease. The sudden occurrence of menopause resulting from
chemotherapy,
oophorectomy, radiation, or
gonadal dysgenesis frequently results in
hot flashes that begin at a younger age and may occur at a greater frequency and intensity than
hot flashes associated with natural menopause.
Hormone therapy relieves symptoms effectively in 80%-90% of women who initiate treatment. This
therapy, however, is generally contraindicated in
estrogen-dependent
cancers, such as
breast cancer, because of the potentially increased risk for recurrence. Many agents have been investigated as potential means for alleviating
hot flashes in survivors of
breast cancer, such as
progestagens,
clonidine,
gabapentin, and anti-depressants. Several complementary and alternative medicines frequently used by patients have also been studied. These include black cohosh,
phytoestrogens,
homeopathy,
vitamin E, acupuncture, and behavior strategies. To support the use of one of more of these nonpharmacological or pharmacological options in the treatment of
hot flashes in
breast cancer patients, more evidence from well-controlled clinical trials is needed. In particular, soundly based scientific research with complementary and
alternative medicine therapies is lacking. Pharmacological treatments appear to be more beneficial than nonpharmacological treatments. This article reviews the current literature to assess the epidemiology and diagnosis of
hot flashes and the nonpharmacological and pharmacological options for the treatment of
hot flashes, in
breast cancer patients in particular. When specific treatment options have not been evaluated in
breast cancer patients specifically, published data on the management of
hot flashes with this modality in healthy postmenopausal women are described.