Endocrine Therapy-Induced Hot Flashes and Traditional Chinese Medicine Approaches

We often see patients in our acupuncture clinic who are going through perimenopause or menopause. Many of them report hot flashes and night sweats. In general, acupuncture and Chinese herbal medicine can help improve these symptoms.

Breast cancer patients who are taking medications such as tamoxifen, letrozole, or anastrozole may also develop a medically induced menopause. This is because these drugs lower estrogen levels in the body.

Both hot flashes and night sweats are known as vasomotor symptoms. They are mainly caused by changes in how the brain regulates body temperature. When estrogen drops, the thermoregulatory neutral zone in the hypothalamus becomes narrower. As a result, even small changes in body temperature can trigger sweating and flushing.

Conventional treatment options include hormone replacement therapy (HRT). However, this is usually not suitable for hormone receptor–positive (HR+) breast cancer patients.

Another option is antidepressants such as SSRIs or SNRIs. However, some SSRIs may interfere with CYP2D6 metabolism. This may reduce the effectiveness of tamoxifen.

Several clinical studies have shown that acupuncture may help reduce endocrine therapy–induced hot flashes in breast cancer patients.

1. JCO Randomized Controlled Trial (Lesi et al., 2016)

In a multicenter randomized controlled trial published in Journal of Clinical Oncology (JCO), 190 women with breast cancer were included.

Patients were randomly assigned into two groups:

• Acupuncture group: received 10 sessions of standardized acupuncture plus self-care education

• Control group: received self-care education only

Main outcome measures:

• Hot flash score (frequency × severity)

• Quality of life scales

• Climacteric symptom scores

Main results:

• The acupuncture group had a significantly lower hot flash score compared to the control group at week 12

• The benefit remained at 3-month and 6-month follow-up

• Quality of life was also improved in the acupuncture group

2. Pooled Analysis of Parallel RCTs (ASCO 2022)

A pooled analysis of multiple randomized trials across the US, China, and Korea studied breast cancer patients on endocrine therapy.

Study design:

• Patients with ≥14 hot flashes per week

• Randomized to:

  • Acupuncture twice weekly for 10 weeks

  • Usual care

Main outcome:

• Change in endocrine symptom scores (FACT-ES)

• Hot flash frequency and severity

Result:

• Acupuncture group showed greater improvement in endocrine-related symptoms and hot flash burden compared with usual care

3. Electroacupuncture vs Gabapentin Trial (JCO 2015)

Another randomized controlled trial compared electroacupuncture with gabapentin in breast cancer survivors with hot flashes.

Study design:

• Electroacupuncture group

• Gabapentin group

• Placebo/sham control conditions included in study design

Main findings:

• Electroacupuncture reduced hot flash frequency and severity

• Effects were comparable to pharmacologic treatment in some outcome measures

• Side effects were generally mild in the acupuncture group

Summary

Across multiple randomized controlled trials, acupuncture shows consistent benefits for:

• Reducing hot flash frequency

• Reducing severity of vasomotor symptoms

• Improving quality of life in breast cancer patients on endocrine therapy

These studies suggest acupuncture may be a useful non-pharmacological option for managing endocrine therapy–induced vasomotor symptoms.

The same treatment approach used in these clinical studies can also be applied to hot flashes and night sweats caused by natural menopause or perimenopause. In clinical practice, we often see similar symptom patterns, and acupuncture tends to provide consistent relief in both groups.

From a Traditional Chinese Medicine perspective, herbal medicine can also be added to support treatment. A commonly used approach is based on Di Huang Wan (地黄丸）, such as Liu Wei Di Huang Wan（六味地黄丸） or Zhi Bai Di Huang Wan（知柏地黄丸）. These formulas are often used to nourish yin and help regulate internal heat, and many patients report good symptom improvement.

However, not all patients tolerate these formulas in the same way. One lady experienced diarrhea after taking formulas. This is because Rehmannia(Di Huang) can have a moistening and mildly laxative effect, and some patients are more sensitive to this.

In general, if a patient can tolerate herbal medicine, combining acupuncture with Chinese herbal treatment may lead to faster symptom control. In typical practice, acupuncture treatment for hot flashes often takes around three months, followed by another two months of follow-up. With the addition of herbal medicine, many patients may experience symptom improvement sooner, and the overall treatment course can be shortened.