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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.
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.
Why: Knowing what to expect, and that help exists, makes it easier to cope and to stay on treatment.
“Offer women information and counselling about the possibility of early menopause and menopausal symptoms associated with breast cancer treatment.”
Why: Hormone replacement could feed a hormone-sensitive cancer; it is contraindicated after breast cancer.
“Do not routinely offer HRT (including oestrogen/progestogen combination) to women with menopausal symptoms and a history of breast cancer.”
Why: These have good evidence, no drug interactions and no effect on the cancer treatment.
“Consider menopause-specific cognitive behavioural therapy (CBT) as an option for vasomotor symptoms associated with menopause: in addition to HRT or for people for whom HRT is contraindicated or for those who prefer not to take HRT.”
Why: These reduce hot flushes; paroxetine and fluoxetine can block the enzyme that turns tamoxifen into its active form.
“Women with breast cancer taking tamoxifen should not be offered paroxetine or fluoxetine because those agents inhibit CYP2D6 activity, which transforms tamoxifen into its active metabolites.”
Why: In a large trial it cut hot flushes in women on endocrine therapy; the label asks for liver monitoring.
“Elinzanetant led to a significantly lower frequency of vasomotor symptoms associated with endocrine therapy than placebo.”
Why: People having treatment for oestrogen-dependent cancers are outside the drug's licence in the UK.
“For people who have had breast cancer or other oestrogen-dependent cancers and are no longer having treatment, any decision to use fezolinetant should be based on an individual risk assessment.”
Why: They have not been shown to work, and some may interact with cancer treatment.
“Do not offer soy (isoflavone), red clover, black cohosh, vitamin E or magnetic devices to treat vasomotor symptoms in women with breast cancer.”
Why: It is the first-line medicine NICE recommends for hot flushes from prostate cancer hormone therapy.
“Offer medroxyprogesterone (20 mg per day), initially for 10 weeks, to manage troublesome hot flushes caused by long-term androgen suppression. Evaluate the effect at the end of the treatment period.”
Why: A second hormonal option exists; complementary treatments have not been shown to help.
“Consider cyproterone acetate (50 mg twice a day for 4 weeks) to treat troublesome hot flushes if medroxyprogesterone is not effective or not tolerated.”
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
For women on breast cancer endocrine therapy: information, no routine HRT, CBT (NICE NG23; NAMS Level I; ASCO 2018), then non-hormonal medicines such as venlafaxine, gabapentin or an SSRI that does not interact with tamoxifen (NICE NG101; CCO; ASCO), and now elinzanetant, the only neurokinin antagonist with a phase 3 trial in this population (OASIS-4); fezolinetant is outside its UK licence during treatment for oestrogen-dependent cancer. For men on androgen deprivation: medroxyprogesterone first, then cyproterone (NICE NG131), with venlafaxine and gabapentin as non-hormonal alternatives (CCO; ASCO). The guidelines disagree on breathing and acupuncture: ASCO recommends slow breathing and CCO calls acupuncture a possible alternative for men, while NAMS does not recommend paced respiration or acupuncture and NICE tells men there is no good-quality evidence for complementary therapies.
NICE 2025 · NICE 2026 · NICE 2021 · NICE 2026 · Cancer Care Ontario, Current Oncology 2017 · ASCO, Journal of Clinical Oncology 2018 · The North American Menopause Society, Menopause 2023 · New England Journal of Medicine 2025 · Bayer HealthCare Pharmaceuticals, via DailyMed (US National Library of Medicine) 2026
Where it differs: Grades options by level: recommends CBT, clinical hypnosis, SSRIs and SNRIs, gabapentin and fezolinetant (Level I), oxybutynin (Levels I to II), weight loss and stellate ganglion block (Levels II to III); does not recommend paced respiration, cooling, trigger avoidance, exercise, yoga, acupuncture, supplements, clonidine or pregabalin.
Evidence: Position statement from a literature review by an advisory panel; read as an abstract. It names oestrogen-dependent cancers as a reason a woman may not be a candidate for hormone therapy.
Where it differs: Puts oestrogen first for women without contraindications, SNRIs (desvenlafaxine or venlafaxine) second, and SSRIs, gabapentin or the neurokinin antagonists elinzanetant or fezolinetant third.
Evidence: GRADE-based; SNRIs conditional with moderate-certainty evidence; neurokinin antagonists conditional with moderate-certainty evidence. Not written for people with cancer. Read as an abstract.
American College of Physicians, Annals of Internal Medicine 2026
Where it differs: Uses acupuncture instead of medicine.
Evidence: CCO says acupuncture might be a suitable alternative, on eleven publications of low quality; NICE NG131 says there is no good-quality evidence for complementary therapies, and NAMS (for women) does not recommend acupuncture.
Cancer Care Ontario, Current Oncology 2017 · NICE 2021 · The North American Menopause Society, Menopause 2023
Where it differs: For premenopausal women whose cancer is not hormone-sensitive and who develop hot flushes from treatment, hormone therapy until about 51 rather than non-hormonal options.
Evidence: CCO expert panel, resting mainly on high-quality guidelines for the general population; it states that hormone-sensitive breast cancer is a contraindication to systemic hormone therapy.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Elinzanetant reduced hot flush frequency at 12 weeks in OASIS-4 “At week 12, the mean change was -7.8 episodes (95% CI, -8.5 to -7.1) among those receiving elinzanetant and -4.2 episodes (95% CI, -5.2 to -3.2) among those receiving placebo (least-squares mean difference, -3.4 episodes; 95% CI, -4.2 to -2.5; P<0.001).” | phase 3 randomised trial, P<0.001 | New England Journal of Medicine 2025 |
| Neurokinin antagonists as third-line treatment in general menopause “or neurokinin receptor antagonists, either elinzanetant or fezolinetant (moderate-certainty evidence).” | conditional recommendation; moderate-certainty evidence (ACP) | American College of Physicians, Annals of Internal Medicine 2026 |
| Medicines for men's hot flushes “The evidence base for these recommendations consists of eleven publications of low quality” | eleven publications of low quality (CCO) | Cancer Care Ontario, Current Oncology 2017 |
| NICE breast cancer recommendations on menopausal symptoms “Consider selective serotonin reuptake inhibitor (SSRI) antidepressants for women with breast cancer for relieving menopausal symptoms, particularly hot flushes, but not for those taking tamoxifen.” | NICE does not grade recommendations | NICE 2025 |
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