Hot flushes on hormone therapy: non-hormonal relief

Hot flushes are one of the most common side effects of tamoxifen and aromatase inhibitors. Hormone replacement therapy is usually avoided after hormone-sensitive breast cancer, but several non-hormonal options help. Practical changes such as layered clothing, a cool bedroom and fewer triggers help many women. Certain medicines, including some antidepressants such as venlafaxine, gabapentin and oxybutynin, reduce flushes for some women. Cognitive behavioural therapy and paced breathing have also been shown to make flushes less bothersome.

Why hormone therapy causes hot flushes

Lower oestrogen levels, or blocked oestrogen signals, affect the part of the brain that controls body temperature. It reacts to small changes by triggering sudden heat, flushing and sweating.

Choosing a medicine safely with tamoxifen

Some antidepressants, such as paroxetine and fluoxetine, can reduce how well tamoxifen works by blocking its activation in the liver. Options such as venlafaxine are preferred for women on tamoxifen. Always check with your team before starting any medicine.

When flushes may point to something else

Night sweats with fever, weight loss or feeling unwell should be reported, because infection or other conditions need to be ruled out.

Non-hormonal options usually reduce hot flushes rather than stop them completely. Many women find a combination of practical changes and, if needed, a medicine makes flushes much more manageable, especially at night.

Medicines have side effects too

Sickness, drowsiness, dry mouth or dizziness can occur. Starting at a low dose and reviewing after a few weeks helps you decide whether the benefit is worth it.

Herbal remedies are uncertain

Products such as black cohosh, red clover and soy supplements are promoted for flushes, but evidence is limited and some contain plant oestrogens. Ask your team before using them.

Flushes often ease with time

For many women, flushes become less frequent after the first year or two of hormone therapy, though some continue to have them longer.

What this page cannot tell you

It cannot tell you which option suits you. Ask your team to review your other medicines and health before choosing.

Approaches that work on how you respond to flushes can make a real difference, without any medicines.

Cognitive behavioural therapy

A short course of CBT, sometimes available in groups or online, has been shown to make flushes and night sweats less bothersome and to improve sleep and mood.

Paced breathing

Slow, deep breathing, about six breaths a minute, practised daily and used at the start of a flush, helps some women feel more in control.

Managing stress

Stress can trigger flushes. Yoga, meditation or simply time outdoors can reduce both stress and the intensity of symptoms.

Night sweats disturb a partner's sleep as well as your own, and constant tiredness can make everyone short-tempered.

Explain what is happening

Family members may not realise that hormone tablets cause these symptoms. A simple explanation helps them understand why you need a cooler room or a fan at night.

Practical compromises

Separate light blankets, a fan on your side of the bed, or a cooler room can let both partners sleep better.

Plan cool evenings

A light dinner, avoiding very hot or spicy food late in the evening, and a lukewarm bath before bed can reduce the night sweats that disturb both partners, and make it easier to fall asleep again after one.

Look after your mood

Poor sleep often brings low mood. If you feel persistently down or anxious, tell your team, as treatment for mood may also ease flushes.