Hot Flashes - came, went, back again?

I have not but side effects from Tamoxifen can last months after you quit taking it. I had joint pain that continued on after my 5 years was up but thankfully only afew months.

Can you take another med? I didn’t have unmanageable issues when I took it. It shouldn’t wreck havoc on your QOL. Besides there are a number of other drugs they can prescribe.

Good luck!

so here's how hot flashes happen:

Estrogen interacts with the hypothalamus to help regulate your body temperature. When there is an imbalance of estrogen the hypothalamus does not always receive the temperature signals correctly. A hot flash occurs because your hypothalamus incorrectly senses that you are hot. In response it sends a signal to your blood vessels closest to the skin surface to dilate rapidly to allow for heat dissipation. Since you really are not hot, when the blood vessels dilate you feel the heat whoosh through you. Your skin temperature can change as much as 8 degrees. (Just ask the lady giving me a facial yesterday-she removed a cool cloth I'd placed on my forehead and she said, “Oooh! Steam!") Yet your core temp stays normal.

Having hot flashes stop and start again can be just a sign that the hypothalamus is having a hard time recognizing true temperature or that the estrogen is indeed fluctuating again. Your case makes it even more difficult to figure out due to the timing of the BC diagnosis, chemo stopping the periods (note that sometimes that's only temporary), the tamoxifen action, stopping tamoxifen, and your age now. My guess would be that since stopping tamoxifen your body is starting to react to the amount of estrogen that is being released from your ovaries. There can also be a backlog of estrogen in your blood stream too - remember tamoxifen does not stop estrogen production, it just prevents it from being able to enter the estrogen receptors on the cells in your body and it can build up in your blood. Meaning your organs/tissues may be getting flooded with it until your blood levels return to normal. Additionally, you still have estrogen being made from the aromatase action in your fat cells on the androgens released from your adrenal glands.

Why could this happen so long after stopping tamoxifen? Tamoxifen has a very long half life. It takes 10 days to get to “steady state" and it has a half life of ~6 days. That means that it takes months and months to get the tamoxifen levels out if your system. If you only took it for 10 days, it would take over 30 days to get it out of your system. As those levels fall, certain organs/tissues will start coming back online slowly and start functioning again.

Additionally, Menopause does not mean there is no more eastrogen being made by your body. Ovaries make ~80% of your estrogen. The adrenal glands release androgens which are converted to estrogen in your fat cells by the enzyme aromatase.This accounts for the other ~20%. Together they make up 100% of your estrogen production before menopause. After menopause, your ovaries stop producing estrogen, meaning 80% of your estrogen stops being produced and now the 20% that was being made by the aromatase activation process becomes your new 100% source of estrogen production. Note that the amount that's being made by this process does not increase. The percentage contribution changed because it is all the estrogen production you've got. It is this process that aromatase inhibitors or AIs prevent from happening.

So yes, your estrogen levels can be in a state of flux months and months after stopping tamoxifen and cause hot flashes and/or discharge

Hope this helps!

NVB, I'm answering yes to the question did anyone get a period after 1.5 years. I was on Lupron and an AI until November. Then this past Sunday woke in the wee hours to be greeted by that old friend. Bleh. But also noted- haven't had a hot flash since Sunday afternoon! The reason I remember is bc we were leaving my family's vacation home when I hot flashed and then remembered I left my Tamoxifen on the kitchen counter. So we turned around to get it.

Thanks Lula for the explanation about how those hot flashes work. Wonder if they'll return after my period is over...

notverybrave, I was just miserable on the combo. I wasn't sleeping because my joints ached, everything hurt a lot, except for sex, which felt like nothing. I mean, my DH could've been rubbing my elbow or my lady parts and it felt no different. So my MO suggested the switch. He wasn't the one who started me on Lupron anyway. I had a brief MO who moved to FL after a few months with him. So I do feel better on Tam. I hope it's treating me right!

I'm new to this forum. Was having horrible hot flashes that kept me up all through the night. Then I started taking Evening Primrose Oil gelcaps - 1200 mg, just once a day, and the flashes disappeared. Tomorrow I'll call my breast surgeon and see if it's ok to take this. I haven't seen any estrogen links so far. (My breast cancer was hormone receptive).

If any one knows about the safety of EPO, I'd love to hear back