Chemotherapy for breast cancer is associated with the development of hot flashes, which can cause the patient considerable discomfort. Estrogen replacement therapy alleviates the number and severity of hot flashes but is contraindicated in such cases. Alternative methods to treat hot flashes are, therefore, urgently needed. Goodwin et al. have performed a 6-month, double-blind, randomized, placebo-controlled trial of megestrol acetate in 286 women with breast cancer. After 3 months, 65% of the patients receiving 20 mg megestrol acetate daily had achieved an appreciable reduction in the number of hot flashes (≥ 75% from baseline), compared with 48% in the 40 mg megestrol acetate group and 14% in the placebo group. The positive effects of megestrol acetate on hot flash frequency were maintained at 6 months. In this Practice Point commentary, I discuss the key findings of Goodwin et al. and place them into clinical context, highlighting the need for additional studies of hormonal therapies in women with breast cancer.