# Hot flushes on breast cancer endocrine therapy and prostate cancer hormone therapy: non-hormonal options

Source: https://onco.cc/protocols/hot-flushes-on-endocrine-therapy-non-hormonal-options/  
OnCo record `hot-flushes-on-endocrine-therapy-non-hormonal-options` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Hormone treatments for breast and prostate cancer often cause hot flushes, sometimes for years. After breast cancer, hormone replacement therapy is usually ruled out. Options include cognitive behavioural therapy, hypnosis, venlafaxine, some SSRIs (not with tamoxifen), gabapentin and, in a large trial, elinzanetant. For men, NICE suggests medroxyprogesterone first. Herbal remedies are not advised.

## Summary

Breast cancer. NICE NG101 asks teams to tell women about early menopause and menopausal symptoms, not to offer HRT routinely after breast cancer (it is contraindicated and off-label; in exceptional circumstances, after discussion of the risks, for severe symptoms), to consider SSRIs for hot flushes but not with tamoxifen, and not to offer soy, red clover, black cohosh, vitamin E or magnetic devices. NICE NG23 (2024) adds menopause-specific cognitive behavioural therapy for vasomotor symptoms where HRT is contraindicated or not wanted. CCO (2016) lists paroxetine, venlafaxine, gabapentin and clonidine as alternatives to hormone therapy and warns against paroxetine and fluoxetine with tamoxifen because they inhibit CYP2D6; ASCO (2018) recommends cognitive behavioural therapy, slow breathing, hypnosis, venlafaxine and gabapentin for women and men. NAMS (2023) grades CBT, clinical hypnosis, SSRIs and SNRIs, gabapentin and fezolinetant as Level I, oxybutynin Levels I to II, and does not recommend paced respiration, cooling techniques, acupuncture, supplements or clonidine.

The neurokinin antagonists. In OASIS-4 (474 women on endocrine therapy for HR-positive breast cancer or its prevention), elinzanetant 120 mg reduced moderate to severe hot flushes by 3.4 more episodes a day than placebo at 12 weeks. The US label (August 2026) is for vasomotor symptoms due to menopause, requires liver tests before starting and at three months, and restricts use with CYP3A4 inhibitors and inducers. Fezolinetant is recommended by NICE (TA1143, 2026) when HRT is unsuitable, but people having treatment for breast cancer or other oestrogen-dependent cancers are outside its marketing authorisation, and after treatment its use should rest on an individual risk assessment. ACP (2026, general menopause) places the neurokinin antagonists third line.

Prostate cancer. NICE NG131 offers medroxyprogesterone 20 mg a day for 10 weeks for troublesome hot flushes from long-term androgen suppression, then cyproterone acetate if that fails, and tells men there is no good-quality evidence for complementary therapies. CCO lists venlafaxine, medroxyprogesterone, cyproterone or gabapentin, and says acupuncture might be a suitable alternative.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: hot flashes on tamoxifen; hot flushes on aromatase inhibitors; vasomotor symptoms on endocrine therapy; hot flushes on androgen deprivation therapy; night sweats on hormone therapy; elinzanetant for hot flushes; fezolinetant after breast cancer
- Tags: protocol; symptom-management; hot-flushes

## Connected records

- protocols: [Bone health on aromatase inhibitors, ovarian suppression and androgen deprivation therapy](https://onco.cc/protocols/bone-health-on-hormone-therapy/), [Sexual health after cancer: assessment and interventions for women and men](https://onco.cc/protocols/sexual-health-assessment-and-interventions/)
- technologies: [Acupuncture for hot flushes on endocrine therapy](https://onco.cc/technologies/acupuncture-hot-flushes/), [Androgen deprivation & AR pathway inhibitors](https://onco.cc/technologies/androgen-deprivation/), [Black cohosh](https://onco.cc/technologies/black-cohosh/), [Clinical hypnosis for procedures, pain and hot flushes](https://onco.cc/technologies/hypnosis-cancer-care/), [Endocrine therapy (SERMs, AIs, SERDs)](https://onco.cc/technologies/endocrine-therapy/), [Menopause brought on by cancer treatment, and the options for it](https://onco.cc/technologies/menopause-after-cancer-treatment/)
- cancers: [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- drugs: [Anastrozole](https://onco.cc/drugs/anastrozole/), [Elinzanetant](https://onco.cc/drugs/elinzanetant/), [Exemestane](https://onco.cc/drugs/exemestane/), [Goserelin / leuprolide (ovarian function suppression)](https://onco.cc/drugs/goserelin/), [Letrozole (and other aromatase inhibitors)](https://onco.cc/drugs/letrozole/), [Leuprolide (leuprorelin) and GnRH agonists](https://onco.cc/drugs/leuprolide/), [Progestins (megestrol acetate, medroxyprogesterone, levonorgestrel IUD)](https://onco.cc/drugs/megestrol-progestins/), [Tamoxifen](https://onco.cc/drugs/tamoxifen/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/), [Ontario Health (Cancer Care Ontario)](https://onco.cc/institutions/ontario-health-cancer-care-ontario/)
- terms: [Androgen deprivation therapy (ADT)](https://onco.cc/terms/adt/), [Aromatase inhibitor](https://onco.cc/terms/aromatase-inhibitor/), [Hot flushes on hormone therapy](https://onco.cc/terms/hot-flushes-on-hormone-therapy/), [Menopause symptoms after chemotherapy for breast cancer](https://onco.cc/terms/menopause-after-chemotherapy-breast/)

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