Alternative Treatments for Hot Flashes with Breast Cancer

Breast cancer patients have a lot to deal with. But when moderate to severe hot flashes occur, especially when they are due to the treatment, it adds another level of challenges. It’s a lot to deal with. Hot flashes significantly affect the quality of life for 53% of women treated with endocrine therapies. In fact, hot flashes are the main reason women think about stopping their treatment. HRT (hormone replacement therapy such as estrogen) would likely solve the problem but it can almost never be used due to risk. So I want to share some alternative treatments to HRT that I prescribe for my patients so you can discuss them with your doctor. There are also many women who don’t have 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 to turn down the heat.

One simple thing is 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. Getting your vitamin D level back to normal often reduces hot flashes and you’ll feel much better. It’s simple; just take a vitamin D3 supplement. It usually takes three months. 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 – 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% improvement.
  • Avoid caffeine, spicy foods and alcohol
  • Carry a cool wipe to remove the sweat. It’s very cooling.

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 from Simon & Schuster.

Women who are thinner have less hot flashes than women who weigh more.

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.