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Hot flushes

Hormone therapy for prostate cancer can cause hot flushes by changing the levels of hormones in your body. 

How does hormone therapy cause hot flushes?

Hormones occur naturally in your body. They control the growth and activity of normal cells. Testosterone is a male hormone mainly made by the testicles.

Prostate cancer usually depends on testosterone to grow. Hormone therapy blocks or lowers the amount of testosterone in the body. This can lower the risk of an early prostate cancer coming back when you have it with other treatments. Or it can shrink an advanced prostate cancer or slow its growth.

Low levels of oestrogen can cause low levels of the hormone norepinephrine. This hormone helps your body to regulate temperature. Low levels of norepinephrine may lead to increases in core body temperature. This can cause hot flushes in women going through the menopause. 

Doctors think this might the same reason that men get hot flushes when they have hormone therapy. 

Some treatments such as goserelin (Zoladex) cause hot flushes in most men. Treatments called anti androgen drugs are less likely to cause hot flushes. An example of an anti androgen is bicalutamide.

For many people, hot flushes gradually get better over several months. For some people the flushes last as long as they are having treatment. They do tend to happen less often over time.

How hot flushes may feel

Hot flushes can vary from one person to another. They can start as a feeling of warmth in your neck or face. This often spreads to other parts of your body. You might have:

  • reddening of the skin
  • light or heavier sweating
  • feelings of your heart beating in your chest (palpitations) 
  • feelings of panic or irritability 

Hot flushes can last between 2 to 30 minutes. You may have a few a month or more often. The flushes usually last for a few months but for some people they carry on for longer. 

They can be disruptive and might make sleeping difficult. 

Tips to help with hot flushes

Environment

  • Keep your room cool – use a fan if necessary.
  • Wear layers of light clothing so you can easily take clothes off if you overheat.
  • Have layers of bedclothes to remove as you need to.
  • Wear natural fibres such as silk or cotton instead of synthetic (artificial) fabrics.
  • Have a lukewarm shower or bath instead of a hot one.
  • Put a towel on your bed if you sweat a lot at night.
  • Cooling pads can help to keep you cool.
  • Try to stay calm under pressure as heightened emotions can cause a hot flush to start.

Diet

  • Cut out coffee, tea and nicotine.
  • Sip cold or iced drinks.
  • Try to drink alcohol in moderation.

Treatment for hot flushes

Medroxyprogesterone

National guidelines advise medroxyprogesterone 20mg per day as the first choice of treatment. Your doctor should review this medication after 10 weeks.

Cyproterone

Your doctor may offer cyproterone 100mg per day if the medroxyprogesterone has not worked for you.

Cyproterone is used to stop the adrenal gland from making testosterone. It can also reduce hot flushes in men. This medicine may not be suitable for everyone.

A study completed in 2010 compared cyproterone with medroxyprogesterone and venlafaxine. It suggested medroxyprogesterone and cyproterone were the most effective in controlling hot flushes.

Antidepressant medicines

Research show that these drugs can be helpful in treating hot flushes in men with prostate cancer. Examples are venlafaxine and paroxetine.

Gabapentin

Gabapentin is a medicine used to treat epilepsy and nerve pain. It can also be helpful in controlling hot flushes but this is rare. 

Other progestogens

Your doctor may consider these medicines for very severe hot flushes if other treatments have not helped you.

Complementary therapies for hot flushes

There is limited scientific evidence that complementary therapies can help hot flushes in men with prostate cancer.

Acupuncture

Small studies suggest people experience less extreme hot flushes whilst having acupuncture.

Cognitive behavioural therapy

This treatment suggests there is a link between your thoughts and actions. It focuses on calming your body and mind and keeping a positive outlook. This may help with hormonal symptoms such as hot flushes.

Coping with prostate cancer

It can be difficult coping with prostate cancer and its treatment. There is support available. 

Last reviewed: 
02 Jul 2019
  • Comparison of physical interventions, behavioural interventions, natural health products, and pharmacologics to manage hot flashes in patients with breast or prostate cancer : Protocol for systematic review incorporating network meta analysis
    B Hutton and others
    Systematic reviews, 2015. Volume 4, Pages 1-7

  • Course and Moderators of Hot Flash Interference during androgen deprivation therapy for prostate cancer: A Matched Comparison
    B Gonzalez and others
    The Journal of Urology, 2015. Volume 194, Pages 690-695

  • How long do the effects of acupuncture on hot flashes persist in cancer patients?
    J Frisk and others
    Supportive care in cancer, 2014. Volume 22, Pages 1409-1415

  • Randomized trial to assess the impact of venlafaxine and soy protein on hot flashes and quality of life in men with prostate cancer
    M Vitolins and others
    Journal of clinical oncology, 2013. Volume 31, Pages 4092-4098

  • Prostate cancer: Diagnosis and management
    National Institute for Clinical and Health Excellence (NICE), 2019. 

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

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