Help! - Hot flushes

[Paul Edwards]

One of our members has just started ADT and complains "These hot flushes are still coming every 30 minutes 24/7. It's nearly 4am and just been woken up again covered in sweat!"

 

What worked for you when you were battling with hot flushes?

[flyingphil]

My experience is that as time has progressed both the frequency and duration of theses 'tropical moments' has decreased to the point of almost being unnoticeable (at just into my fourth, three monthly Zoladex depot)

 

To assist with sleeping, I found that placing a pedestal fan at the end of the bed seemed to contain the degree of the 'flush' so that I would wake up much less often.

 

Take heart; 'things' do improve.

 

 

[Charles (Chuck) Maack]

Review this paper since there may be other side effects experienced while on ADT.  Dealing with hot flashes/flushes included.​

http://tinyurl.com/3p9pl3p 

[Euan]

Hi Paul,

 

I had 2 years of ADT but found my hot flushes were only mild and went away after a few months. All GPs will be quite familiar with hot flushes and their treatment and will have their favourite go to med.

 

Here is an article based on my research of what works. It is in order of effectiveness and does not take into account either cost or side effects. 

 

The cause of this vasomotor disruption is principally due to changes in oestrogen levels (estrogen in US). There are other loss of oestrogen effects as well, most notably bone loss and this can be very serious and in men especially a fall and bone fracture is more likely to be lethal than in women. If you have not had a bone mineral density check (DXA scan) it is important that you do so. You should be able to get one bulk billed.

 

But back to the hot flushes. For the best article on hot flushes I could find see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032775/.

 

In the following summary the numbers in brackets are PubMed references to studies that have been done. Just copy and past into Google and the study summary will be available for more information. Also within each group I have listed the treatments in roughly the order of effectiveness and ignoring potential side effects. However, it is likely best to start with the minimal side effects first. Doctors are familiar with hot flushes because many woman report this,

 

Lifestyle changes.

1. avoid caffeine, hot drinks, chocolate, spicy or hot foods and alcohol (16414341).

2. maintaining blood glucose levels may be effective in reducing hot flushes (17489931)

3. exercise may have some benefit if previously sedentary (3469216) and (22673453)

 

Drug Treatments.

There are a number of drugs that are effective for hot flushes but only oestrogen patches are subsidised. For the others none are listed on the PBS for hot flushes so you must otherwise qualify or pay full price.

 

1. oestrogen (10654902).

Low-dose oestrogen is subsidised by the PBS, and may simultaneously reduce hot flushes and the risk of osteoporosis in men receiving long-term androgen suppression therapy.

Breast development (gynecomastia) is a potential problem but a little radiation prior will likely stop this (3957739). If breast pain or nipple tenderness develops then radiation can still help (2458332). 

 

2. cyproterone acetate (brand name Androcur®) an antiandrogen (19963436).

This drug is available on the PBS for “Advanced carcinoma of the prostate”. However it is known to cause liver toxicity and requires regular monitoring because of this.

 

Paul I first started on Androcur as do a lot of men for the first month and this was to nullify the effects of flare when starting on LHRH agonists (Zoladex®). I can report that indeed I had no hot flushes until my second injection of Zoladex.

 

3. gabapentin an analgesic and anti-epileptic (16816054)

This is a cheap drug at full price and very effective for hot flushes. About 1/4 of patients experience headache, dizziness, and disorientation.

 

4. megestrol a hormone for advanced breast cancer (8028614)

Low-dose megestrol acetate is well tolerated and can substantially decrease the frequency of hot flashes in women and men.

 

5. medroxyprogesterone (Provera) a hormone for breast and endometrial cancers and endometriosis (19963436).

 

6. antidepressants.

Not as effective as the above hormone drugs but are proven to help some. May cause nausea, drowsiness, dry mouth, and changes in appetite.

Paroxetine a Selective Serotonin Reuptake Inhibitor (SSRI) is a cheap drug at full price (15473404).

Venlafaxine a serotonin-norepinephrine reuptake inhibitor (SNRI) (19963436).

 

7. clonidine an antihypertensive drug (8439695)

Not as effective as the hormone drugs but might be a good choice for anyone with high blood pressure. May cause dry mouth, drowsiness, constipation, and insomnia.

 

Complimentary and Alternative Treatments.

 

1. relaxation therapy (23149867) and/or mindfulness meditation stress reduction (21372745).

 

2. hypnotherapy. The hypnosis group had five weekly sessions, where mental images of coolness, a safe place, or relaxation were offered. They also listened to hypnosis audio at home (23096250).

 

3. femal, a herbal remedy made from pollen extracts appears to have some benefit (16096172)

 

4. a once-daily tablet of fresh sage may have value in the treatment of hot flushes (21630133). Also (9677811). But caution, these were not placebo controlled studies.

 

5. vitamin E also appears to show some improvement (17664882).

 

6. there have been many studies on isoflavones which are found in legumes such as soy and red clover and other phytoestrogens such as ginseng and flaxseed. Also black cohosh has been well studied and all with mixed results. However, a combination product containing black cohosh, dong quai, milk thistle, red clover, American ginseng, chaste-tree berry has shown some effectiveness (17454163). When I checked the local super market most products were single ingredient and mostly black cohosh. However, one called “Menopause” by Natures Way did contain soy, red clover, wild yam, dong quai, chaste tree and black cohosh. So you never know it might just help. However, caution with black cohosh there is reported to be rare liver damage (22972105).

 

So there you have it. It is well studied and there are lots of treatments to try so if one does not work move on to the next one. This is one area where placebo is effective and almost all the over the counter preparations are no better than placebo so many people will have their favourite.

 

I hope this helps a little.

[Paul]

No tablets work

What works and worked for me was

Gel Ice pack specialty made in fabric material - these are made with dry gel crystals that expand when placed in water then freeze

I had a few sizes and one that went around my neck

Cool air fan at night

 

Deeply inhaling also works to a lesser degree 

Cool air fills the lungs and expels the heat

 

Paul