PATIENT QUESTION: Is there anything that can be done for menopausal symptoms that doesn't include taking hormones? I've had breast cancer in the past so am unable to take hormones, but I wake up nearly every night because of night sweats and have occasional hot flashes during the day.
ANSWER: There are options for managing night sweats and hot flashes that do not involve taking hormones. Many women find that making some lifestyle changes can make a big difference. In addition, several prescription medications that do not contain hormones are available to treat hot flashes.
As you mention, doctors often advise women who have had breast cancer not to take hormone therapy for menopause symptoms. But that does not mean you have to simply suffer through those symptoms.
A good first step is to take a look at adjustments you can make in your day-to-day routines. For example, staying cool and lowering your stress can reduce the likelihood of hot flashes and night sweats. Some tips that may help include the following:
Try to avoid hot, spicy foods, warm beverages, caffeine and alcohol, as these are common hot flash triggers. When choosing clothing in the morning, dress in layers, so you can remove a layer if you get too warm. Pick light, breathable fabrics.
To minimize night sweats, make your bedroom cool and comfortable. Lower the temperature in your room and use layers of bedding you can remove easily during the night. Keep a small fan near your bedside, along with a glass of cold water. Some women put a frozen cold pack under their pillow, too.
To lower your stress and to help you sleep better, exercise regularly. Other stress reduction techniques such as meditation, yoga, qigong, tai chi, acupuncture and massage can also be useful. When used during hot flashes, a form of deep breathing called paced respirations may also reduce your symptoms.
Making choices to improve your health can make a difference, too. For example, along with other serious health problems, smoking raises your risk for hot flashes. If you smoke, talk to your health care provider about programs and resources in your area that can help you stop smoking. Your weight can also have an impact. Women who are overweight tend to have more hot flashes, so try to get to and stay at a healthy weight.
If lifestyle changes are not enough to give you relief from hot flashes, you may want to consider taking a prescription medication that does not contain hormones. A number of options are available. For your situation, a drug called gabapentin may be a good choice. Gabapentin can also cause drowsiness, so it is often recommended for women who have bothersome night sweats.
Other medications that can be effective include certain drugs that are approved to treat depression, but also reduce hot flashes in women without depression. Venlafaxine, escitalopram and paroxetine are examples of these medications. But be aware that you should not take paroxetine if you take tamoxifen for breast cancer.
Some people tout nonprescription medications as being useful for reducing hot flashes. Be careful with these. In many cases, their effectiveness has not been confirmed. Some of them are associated with an increased risk of other health problems. The herbal supplement black cohosh, for instance, is sometimes cited as being useful for minimizing hot flashes. But it has not been shown to be effective, and it may be linked to liver damage.
If you are interested in taking medication for your hot flashes, talk to your doctor about which one is right for you. It may also be useful to talk with a physician who specializes in women's health issues. At Mayo Clinic, specialists in the Women's Health Clinic are available for this purpose. Many other health care organizations offer this type of service, as well.
-- Stephanie Faubion, M.D., Women's Health Clinic, Mayo Clinic, Rochester, Minn.