Ask A Doctor - Gynecology

---

Q.
After a hysterectomy, hot flashes and night sweats have become a problem. I cannot take hormones because of a history of breast cancer. I’m currently taking tamoxifen. What can be done to relieve the hot flashes?
A.
Tamoxifen, an anti-estrogen drug given for 5 years after cancer treatment, exaggerates hot flashes and night sweats. They will get better once tamoxifen treatment ends. Lifestyle changes that will increase your comfort are: cooling the air temperature in the room, selecting layered clothing, eating cool/cold food and drink, decreasing caffeine intake, and avoiding hot or spicy food. Exercising, maintaining an ideal body weight, quitting smoking, and decreasing alcohol intake can also help. Simple relaxation techniques--slow, controlled paced breathing will reduce hot flashes by 50%. Other stress management techniques that are beneficial are tai chi, yoga, and meditation. Several non-hormonal drug therapies are available. Effexor reduces hot flashes by a significant percentage, but some patients experience uncomfortable side effect. Blood pressure can also rise. SSRI’s like Paxil, Prozac, and others reduce hot flashes; however they can lower the efficacy of the Tamoxifen. Gabapentin reduces hot flashes by about 50%, but again has side effects. Herbal remedies like Estrovert and Remifemin can help for short periods. Black cohash in large doses can cause liver toxicity. Soy, isoflavones, and red clover are not very helpful, and larger doses can have an estrogen effect on breast tissue. It is better to avoid these supplements in your case.
Q.
Is a pap smear still needed after a full hysterectomy?
A.
Post-hysterectomy patients with prior normal pap smears are at low risk for genital cancers; their pap may even be omitted during their check up. The doctor’s advice of whether to continue pap smears will be based on factors such as the woman’s age, medical and family history, and risk factors. Those with pre-cancer and cancers should continue with pap smears after a hysterectomy. Patients with risk factors such a HPV infection, multiple partners, partners with HPV, HIV, or organ transplant need to continue having pap smears, as do smokers. In women who have not had a hysterectomy, screening pap smears may be stopped after the age of 70 if the patient has had 3 negative smears in 10 years. However, and this is important, yearly pelvic exams should still be continued. Advances in pap smears enable liquid-based cell cytology to test for sexually transmitted diseases like G.C., Chlamydia, HPV, and Herpes.