Treating Hot Flashes in Breast Cancer Survivors: A Review of Alternative Treatments to Hormone Replacement Therapy

Abstract

As the number of breast cancer survivors continues to grow, factors associated with quality of life are receiving increased clinical and research attention. This attention is imperative given the aftermath of psychological and physiologic side effects that commonly result from a cancer diagnosis and cancer-related treatments, including menopausal symptoms. Hot flashes, the most prevalent of these symptoms, have been shown to significantly decrease quality of life in women. Although manageable with hormone replacement therapy (HRT), hot flashes often are especially problematic in breast cancer survivors, a population that typically is not treated with HRT because of controversial evidence of a relationship among estrogen and/or progesterone and breast cancer recurrence and mortality. Furthermore, hot flashes commonly are more severe in premenopausal women who experience acute menopause as a result of chemotherapy treatment. In recent years, several treatment alternatives to HRT have been investigated. Given the significant number of women affected by breast cancer and the negative impact that hot flashes can have on their quality of life, this article reviews alternatives to HRT for reducing hot flash symptoms in breast cancer survivors.

Combination Treatment of Tamoxifen with Risperidone in Breast Cancer

“…Hormone replacement therapy (HRT) that used for menopause hot flushes is a controversial option for breast cancer patients because of a relationship among estrogen and/or progesterone and breast cancer recurrence and mortality [62], [63]. Among nonhormonal treatment alternatives, SSRIs antidepressants are one of the most commonly prescribed options for hot flushes in breast cancer patients [64], [65], [66]. Unfortunately, many SSRIs such as fluoxetine and paroxetine are known to strongly inhibit cytochrome P450 2D6 (CYP2D6) which is an essential isoenzyme for tamoxifen metabolism.…”

Holding it all together: Breast cancer and its impact on life for younger women

“…Specific concerns identified in earlier research have related to the phase of life of younger women, which is premenopausal. The disruption of ovarian function with resultant clinically induced menopause and infertility and the subsequent psychological sequelae of anxiety and distress are reported consistently in research (Graf & Geller 2003;Knobf 2001).…”

Sexual Dysfunction Related to the Treatment of Young Women With Breast Cancer

“…Younger women may experience only a temporary loss of ovarian function, but they remain at increased risk of early menopause (Ganz et al, 2003;YoungMcCaughan). The sudden onset of menopause related to cancer treatment is more symptomatic than a gradual menopause and has a greater impact on women's quality of life because they have a higher potential for sexual dysfunction (Ganz et al, 2003;Graf & Geller, 2003;Lindley, Vasa, Sawyer, & Winer, 1998;Young-McCaughan). Symptoms are more severe and result in more distress with acute onset of menopause rather than gradual menopause (Schover, 1991;Wilmoth & Ross, 1997).…”

“…Acute loss of ovarian function with resulting premature menopause causes severe vasomotor instability (hot fl ashes), vaginal dryness and atrophy, weight changes, impaired fertility, diminished libido, and dyspareunia (Dorval et al, 1998;Graf & Geller, 2003;Schover, 1991;Wilmoth & Ross, 1997;Young-McCaughan, 1996). Vaginal dryness is a common complaint related to sexual dysfunction that diminishes desire, arousal, and the capacity for orgasm (Bruner & Boyd, 1999;Meyerowitz, Desmond, Rowland, Wyatt, & Ganz, 1999).…”