Hot Flashes and Sweating

Many people with cancer experience hot flashes or sweating, including night sweats. This can happen to people of any gender.

Hot flashes and sweating are some of the most common side effects of hormone therapy for breast, prostate, and endometrial cancers. There may be treatments available to help you manage your symptoms.

What are hot flashes and sweating?

Hot flashes are recurrent (happens more than once) feelings of sudden warmth, often over the face, neck, and chest. They can make you sweat and turn red. Sweating (also called perspiration or diaphoresis) is your body’s way of cooling down. When hot flashes happen at night, they’re called night sweats (or sleep hyperhidrosis).

Hot flashes and night sweats are sometimes called vasomotor symptoms.

What causes hot flashes, sweating, and night sweats?

Hot flashes are usually related to hormone changes in your body. How exactly these hormone changes create hot flashes isn’t entirely understood, but a part of the brain called the hypothalamus is involved. (Your hypothalamus is your body’s internal thermostat.)

Certain types of cancer treatment such as chemotherapy, radiation, and hormone (endocrine) therapy can affect your body’s hormone levels. This sometimes causes symptoms of hot flashes and sweating.

• Aromatase inhibitors (AIs) such as anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara)
• Selective estrogen receptor modulators (SERMs) such as such as tamoxifen and raloxifene
• Selective estrogen receptor degraders (SERDs) such as fulvestrant (Faslodex) and elacestrant (Orserdu)
• Luteinizing hormone-releasing hormone (LHRH) agonists such as leuprolide (Lupron) and goserelin (Zoladex)
• Anti-androgens, also called androgen deprivation therapy or ADT, such as apalutamide (Erleada), enzalutamide (Xtandi), darolutamide (Nubeqa), bicalutamide (Casodex), flutamide (Eulexin), and nilutamide.
• Progestins such as medroxyprogesterone acetate (Provera) and megestrol acetate (Megace)
• Surgery to remove the ovaries (oophorectomy) or testicles (orchiectomy)

Cancers such as lymphoma can also cause night sweats.

People who get hormone therapy for breast, prostate, and endometrial cancers are more likely to experience hot flashes and sweating compared to people getting other types of cancer treatment.

Other possible causes of hot flashes or sweating include:

• Physical activity
• Emotional or physical distress
• Infection or fever
• Menopause
• Certain medications, especially antidepressants
• Thyroid problems
• Low blood sugar

Signs and symptoms

Sweating can vary in intensity from mild clamminess to drenching sweats that require you to change your clothes or sheets. You might sweat even when it’s cold. Sweating is the most common sign of hot flashes, but there are other symptoms you might also experience, such as:

• Sensations of warmth or flushing
• Chills or shaking
• Pink or red skin
• Fever followed by heavy sweating as your temperature goes back down
• Feeling unusually hot in one or more areas of your body
• Heart palpitations
• Anxiety

If hot flashes or sweating continue for a long time, it’s common to have fatigue or sleep problems as well.

Treatments

Sometimes, medicines can be used to help with hot flashes. Hormone therapy has been the main treatment for hot flashes and other menopause symptoms, but there are non-hormone options as well.

Because every person's situation is different, it's important to talk to your cancer care team about what treatment is best for you.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is most commonly used to treat hot flashes or sweating related to low estrogen levels. For cancer survivors with an intact uterus, progestin may also be used. HRT may also be called menopause replacement therapy (MRT).

HRT comes in different forms, including oral (pill), transdermal (patch or cream applied to the skin), vaginal, and intrauterine device (IUD).

Duavee for vasomotor symptoms: Duvee is one medication that is FDA approved to reduce vasomotor symptoms including hot flashes. It works by combining conjugated (mixed) estrogen hormones with a selective estrogen receptor modulator (SERM). Currently, there is no generic version or equivalent of Duavee.

For hot flashes and sweating related to low testosterone levels: HRT can include testosterone, medroxyprogesterone acetate (MPA), cyproterone acetate (Androcur), or estrogen.

Risks and side effects of HRT: Some people shouldn’t take HRT because of the possible risks or side effects. Whether or not HRT is an option for you depends on the type and stage of your cancer, as well as other factors like your genes (DNA).

HRT might not be an option if you have certain health conditions, or if you are at risk for developing them. For example, if have an increased risk for certain types of cancer, hormone replacement therapy can increase your risk even more.

Other options (non-hormone)

Prescription medications

There are two non-hormone medications currently FDA-approved to treat moderate to severe hot flashes.

• Fezolinetant (Veozah) blocks certain chemicals in the brain that are linked to hot flashes.
• Brisdelle (paroxetine) is a selective serotonin reuptake inhibitor (SSRI) approved only for hot flashes (not depression like other SSRIs).

Off-label medications

Some medications are used off-label to treat hot flashes, including:

• Several serotonin norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) typically used for depression
• Gabapentin and pregabalin (anticonvulsant medications often used for seizures, nerve pain, and restless leg syndrome)
• Oxybutynin, a type of anticholinergic medication commonly used to treat overactive bladder symptoms
• Clonidine, an alpha-agonist medication commonly used to treat high blood pressure (hypertension)

Dietary supplements

Certain vitamins, minerals, and other supplements have been suggested as helpful for sweating and hot flashes. But there isn’t enough quality evidence to know if they are safe and effective for people with a history of cancer.

Always talk with your doctor or cancer care team before starting or stopping any medications or supplements.

Tips for preventing and managing hot flashes and sweating

In addition to treatments, there are ways you might be able to reduce the intensity or frequency of hot flashes and sweating.

Stay cool. Wear light clothing and keep your room cool. Look for cooling sheets or sheets made of materials like bamboo, silk, linen, cotton percale, or lyocell (Tencel). Fabrics like cotton, jersey, flannel, and polyester tend to be hotter and don’t pull away moisture as well.  

Dress in layers. Wear 2 layers of clothing in cooler temperatures. The layer on the inside will act as a wick to pull moisture up and away from your skin. Then you can remove outer layers as needed.

Avoid triggers. Spicy foods, caffeine, alcohol, and tobacco can trigger hot flashes or make them worse.

Practice relaxation. Deep breathing and meditation can help.

Stay hydrated. Drink plenty of water to stay cool.

Maintain a healthy weight. Everyone is different. Talk to your doctor about what a healthy weight means for you. Physical activity and good nutrition should be part of your conversations about healthy weight.

Try complementary therapies. Acupuncture, yoga, and hypnosis have been shown to help some people with hot flashes.

Track episodes of sweating and hot flashes. If your sweating is from fevers, take and track your temperature as instructed.

Take care of your skin. Use good personal hygiene and take care of your skin. For example, if you’re sweating a lot, bathe or shower at least once a day and put on a moisturizer as needed, good hygiene and to soothe your skin. Change wet clothes and bed linens as soon as you can.

Talk to your health care team. Tell them if you’re having symptoms. It’s important to rule out other possible causes that might need to be treated.

Also, talk to your health care team before trying any over-the-counter medicine, or any vitamin, mineral, or nutritional supplement that you think might help. Let them know if your antiperspirant or deodorant isn’t working well.

You should also tell them if you’re having emotional distress because of hot flashes or sweating. They might have resources or other ideas for you to try.

When to call your doctor or cancer care team

Let your health care team know as soon as possible if you:

• Can’t sleep for more than 2 days because of night sweats or hot flashes
• Also have signs or symptoms of infection such as  fever
• Have tremors or shaking chills that don't go away
• Have any signs of skin breakdown or pressure sores because of prolonged skin contact with moisture

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