Hot flashes are related to hormonal changes as a result of chemotherapy, endocrine therapy or menopause.
They usually improve over time though some women may experience difficulty for years.
Pharmacological interventions can include:
- Venlafaxine 37.5 to 75 mg once daily (safe for use with tamoxifen)
- Citalopram 20 mg (safe for use with tamoxifen)
- Clonidine 0.05 mg
- Oxybutynin 2.5 mg od or bid (off label use)
- Gabapentin – start with 100 mg od and titrate up over 1 month to maximum dose of 300 mg tid; side effects often limit use
Herbal remedies are strongly discouraged as most that are recommended for hot flashes contain estrogen
Vaginal dryness / dyspareunia:
- Can become a significant problem with the use aromatase inhibitors (letrozole, anastrazole, exemestane)
- Use of vaginal moisturizer (e.g. Replens TM) three times weekly AND a thick lubricant prior to sexual activity
- Estrogen containing products are generally NOT recommended including topical preparations
- Refer severe problems to a gynecologist