Changes in hot flashes in women with breast cancer

March 24, 2020

A study in Menopause found that a significant proportion of premenopausal and perimenopausal women experienced hot flashes after receiving breast cancer treatment.

study in the journal Menopause found that a significant proportion of premenopausal and perimenopausal women experienced hot flashes after receiving breast cancer treatment. The Taiwanese investigators said women with breast cancer who have increased body mass index (BMI) changes or those that still regularly menstruate are particularly vulnerable to them.

The percentage of Taiwanese women younger than age 50 diagnosed with breast cancer is roughly 50%, compared to only around 20% in either the United States or the United Kingdom. In addition, many Taiwanese women are still menstruating at the time of diagnosis.

Methods
The study consisted of 90 perimenopausal or premenopausal women newly diagnosed with breast cancer and scheduled to receive chemotherapy and hormonal therapy at Chang Gung Memorial Hospital in Taipei City. Mean age of participants was 43.86 years and age at menarche was 13.06 years. In total, 87.8% of women were still regularly menstruating (premenopausal) and 12.2% had irregular menstruation (perimenopausal).

Hot flash frequency and other symptoms were measured six times from prechemotherapy to 24 months after chemotherapy. Hot flash frequency was determined by an author-developed diary, in which women were asked to record every episode of a perceived daytime hot flash, and recalled nighttime hot flashes upon awakening the next morning.

The degree of hot flash interference with daily activities and overall quality of life was measured by the 10-item Hot Flash-Related Daily Interference Scale (HFRDIS), which including work, social activities, leisure activities, sleep and mood. Anxiety, depression and loss of sex were based on the Greene Climacteric Scale (GCS).

The prechemotherapy occurrence rate of hot flashes was 7.9%, which rapidly escalated to 42.5% by the end of chemotherapy, and then slightly increased to the highest rate of 46.8% at 6 months after completing chemotherapy. The frequency of hot flashes during the 24-month follow-up period following completion of chemotherapy ranged from 39.7% to 46.8%, significantly higher than baseline.

Findings
Three significant predictors of hot flash frequency were menstrual status ( =  0.006), loss of interest in sex ( =  0.013) and BMI change ( =  0.020). At any time point, increased BMI was associated with both higher hot flash frequency ( =  0.020) and hot flash interference ( =  0.002), while anxiety (P  <  0.001) and loss of sexual desire (P =  0.038) were linked to higher hot flash interference. 

The connection between loss of interest in sex and hot flashes was expected, according to the authors, because they are considered symptoms of menopause, with reduced estrogen as perhaps the common cause of both.

Six months after completing chemotherapy, premenopausal women reported significantly higher hot flash frequency than perimenopausal women (P  =  0.041).

Conclusions
“The abrupt decline of estrogen due to chemotherapy may be the cause of HFS occurring more frequently in premenopausal women than in perimenopausal women,” the authors wrote. “Indeed, the abrupt decrease in estrogen after removing the ovaries and fallopian tubes results in more severe climacteric symptoms than in natural menopause.”

Weight control and stress management programs are two strategies that may help breast cancer survivors cope with hot flashes caused by cancer treatment.