I would suggest that you stop tamoxifen. Tamoxifen is a selective estrogen receptor modulator
and can exacerbate flashes tremendously. If you are truly menopausal meaning that the blood test
for FSH is elevated and remains elevated for six months with no return of menses then you may be a candidate for an aromatase inhibitor
instead of a selective estrogen receptor modulator. You would need to discuss this with your oncologist
was more familiar with the receptor type and staging grade of your cancer. However you state the cancer was in 2009 and there is probably not a great deal of additional benefit after five years of adjuvant therapy
. Again this is a matter to discuss with your oncologist. Effexor is probably benefiting your hot flashes making them less intense. Perhaps instead of 100 mg a day you could take 50 mg twice a day spreading it out a little more evenly with a little better coverage for the flashes.
I should also point out that the hot flashes may not be the only cause of fatigue. Sarcoidosis
is an autoimmune disease
and fatigue is often a component of the autoimmune process. There are great many new medications out to help cheat autoimmune disease without some of the terrible side effects of steroids. You may wish to visit revisit this issue with a specialist in the treatment of sarcoidosis. I hope you feel better soon.