Hot flushes are a common problem with tamoxifen but they often disappear within a month or so of starting the drug. For some women, however, the problem continues and can be very troublesome. When this happens there are a number of different ways to try and improve things.
Tamoxifen is made by a number of different manufacturers and sometimes a change in the brand of the drug (which your GP can arrange for you) will make a difference. Also dividing the daily dose of the tablet: taking half in the morning and half in the evening may help.
If this fails, a number of different prescription drugs may help. These include clonidine, which has an effect on the small blood vessels in the skin and can sometimes reduce flushing, but its effects tend to wear off with time. The antidepressant, Efexor (venlafaxine) used in small doses may also be effective in relieving flushing. Sometimes hormones known as progestogens are prescribed, for example Megace or Provera.
Some women find complementary treatments helpful. Evening primrose oil is a popular, although expensive, remedy and a variety of other preparations are available. If you do decide to try this approach be sure to check the ingredients of any preparation you intend to buy as some of them do contain oestrogens (often derived from plants and called phyto-oestrogens) and these should be avoided as there is a risk that they could stimulate the development of breast cancer. Some women say that acupuncture and reflexology have also helped to minimise hot flushes and sweats. Complementary therapies like these are sometimes available on the NHS.
If none of these treatment work for you and the flushes continue to be a severe and distressing problem, there are other options - it can help some women to change tamoxifen to another type of hormone therapy.
In recent years several new hormonal preparations have become available for the treatment of breast cancer. These act in a different way to tamoxifen but are as effective in breast cancer treatment and prevention. Often they cause fewer side-effects than tamoxifen so your specialist may consider that changing to one of these drugs, such as anastrozole (Arimidex) would be a good idea.
Since HRT contains oestrogen, which could theoretically encourage the growth of breast cancer cells, doctors generally do not recommend women with secondary breast cancer to have this treatment, although it may be safe for women with oestrogen-receptor negative cancer. Studies are being done to see whether HRT is safe for women with breast cancer to take.