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Behavioral and Lifestyle Management
*	 Avoid your personal triggers. Some people have identifiable patterns to their hot flashes. Keeping a hot flash diary can help you identify your personal triggers6. For example, you may find
that alcohol, spicy foods, hot beverages, or caffeine significantly worsen your hot flashes. If so,
you can feel better by steering clear of them.
*	 Stop smoking. Studies show that women who smoke have more severe hot flashes5,6,7.
*	 Find ways to manage stress. Studies have found that stress and anxiety can impact hot flashes6,7.
Engaging in relaxation techniques like yoga, massage, meditation, and guided imagery may
minimize these emotional triggers.
*	 Aim for a healthy weight. Research shows that being overweight is associated with hot flashes,
and that weight loss can reduce them5,6,7.
*	 Exercise. While physical activity may not directly decrease hot flashes (and vigorous exercise
might actually trigger them by increasing your core body temperature6), exercise may provide
relief indirectly by improving sleep, promoting a healthy weight, and reducing stress2,5.
*	 Be prepared. There are also things you can do that may not prevent hot flashes from occurring,
but can help you deal with them when they do6,7. Examples include dressing in layers, keeping
cold water nearby to drink, strategically placing fans where you spend most of your time (which
can include stashing a handheld one in your car or your bag), sleeping with a fan, using layered
bedding, and keeping clean sheets by the bedside if you wake up with night sweats.
Prescription Medications
The most studied interventions for hot flashes are prescription medications. These include hormonal and
non-hormonal pharmacologic options. If your hot flashes are harsh enough that they are significantly
impacting your life, a prescription medicine may be appropriate for you.
Hormone Therapy
The most effective treatment for menopausal hot flashes in the general population and in cancer survivors
is hormone therapy5,6. Young women who experience early menopause due to cancer treatment may be
recommended to replace their hormone levels by taking hormonal oral contraceptives or hormone therapy
until they reach the average age of natural menopause (about 51)5,6, which typically relieves hot flashes.
However, if you have had a cancer that is hormone-sensitive, these medicines are not recommended5,7. Other non-cancer considerations for avoiding hormone therapies include cardiovascular
disease, history of blood clots or stroke, and being a smoker5,6. Talk with your provider about the
risks and benefits of taking hormones for your symptoms.
Non-Hormonal Prescription Medications
For women who do not wish to take hormones or who are recommended to avoid hormone therapy, there
are non-hormonal prescription medications that have also been found effective for hot flashes.
*	 Low-dose antidepressants. Selective Serotonin and Norepinephrine Reuptake Inhibitors (SSRIs/SNRIs) have been studied in both cancer and non-cancer populations for treatment of
hot flashes5. While paroxetine is the only SSRI/SNRI that is FDA approved for this purpose, it
should not be used in women who are also taking tamoxifen5. Venlafaxine is commonly recommended for survivors2,5.
*	 Gabapentin. This neurologic/anti-seizure medicine has also been studied and found to reduce
hot flashes in cancer populations5,7. It is sometimes prescribed to treat peripheral neuropathies
from chemo, so if you are experiencing both bothersome side effects, taking it may kill two birds
with one stone! Because this medication can cause sleepiness or sedation, taking it at night can
help mitigate this side effect5 while also reducing nighttime hot flashes7.
*	 Clonidine. This high blood pressure medicine has been found to improve hot flashes in breast
cancer survivors, including women taking tamoxifen5,8. Although not as often used as the other
prescription medicines7, it may be an option for you.
All prescription medicines have potential adverse side effects that do not make them right for
everyone7, so talk with your provider about where to start. Also, if one medicine doesn't improve
your symptoms, changing to a different one could help.

A DAY AT THE BEACH:
THE EMOTIONAL TOLL OF HOT FLASHES
On a personal note, I will say that my years
(six and counting) of treatment-induced
hot flashes have made my Wisconsin
winters much more bearable! And my
supportive husband has been well-trained
to react to my cues; the minute I begin
the process of de-layering, he holds out
his arms to catch my purse and whatever
articles of clothing I'm tearing off, ready to
fan me with a piece of junk mail or a magazine or whatever happens to be available (I
think potato chip bags have been used).
But all joking aside, these constant hot
flashes are not only super annoying;
they are also a persistent reminder of my
cancer, and they have a way of making
me feel older than I am. It's sort of like I'm
watching all my 30-something friends live
typical 30-something lives, while I'm on the
sideline in my aging body. Where did my
30-something life go!? And it doesn't help
when well-meaning older women see me
in the middle of a heat wave and exclaim
" Oh honey, you're too young for that! "
Believe me, I'm aware.
Sometimes when I have a hot flash, I try
to imagine myself at the beach, with the
sun on my skin. Those warm golden rays...
scalding my face. I have also heard that we
could try to think about hot flashes as power surges1, instead. It's an interesting twist
in perspective. Can I challenge myself to
think of that swell of heat rising within me
as strength, rather than suffocation? Can
I somehow harness that power for good?
Can I use it as a reminder to recenter
myself in the present moment? Can I use it
to prove to myself that I am here? Because
I am still here.
And I guess, each day that I am here to
experience the ragingly intense wrath of
a hot flash means that I am also still here
to experience and be grateful for all of the
good in my life, too. Like ice cream cake.
And my new, insane tolerance of those
frigid winds coming off the beautiful Lake
Michigan. And the blessed human who invented my battery-operated fan necklace.
Because let's be honest; that's just genius!

ELEPHANTSANDTEA.COM
MARCH 2021

35



Elephants And Tea - March 2021

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