Updated: Nov 8
Breast cancer ranks the second most common cancer in the UK, affecting over 55,000 women annually.
As the incidence of breast cancer increases, so does survival, but this leads many more women to live with the long-term effects of cancer and its treatment. For breast cancer survivors, navigating menopause can be exceptionally intricate. Not only can breast cancer treatment trigger menopause, but it can also complicate the use of conventional menopause medications.
Breast cancer incidence is strongly related to age. Rising steadily from 25-29 and more steeply from 35-39.
Younger women with breast cancer have unique health and emotional challenges that can lead to a lower quality of life. These unique challenges encompass worries about fertility, the consequences it may have, and the associated menopausal complexities. The experience of survivorship following a breast cancer diagnosis is inherently individual. Still, many young women must confront the added physical and emotional burdens of early-onset menopause. These complexities necessitate specialised care and support tailored to the distinctive needs of this demographic.
Breast cancer treatment significantly impacts hormonal balance, often resulting in menopause or its symptoms. If you haven't reached menopause when diagnosed, certain treatments might push you into either temporary or permanent menopause. This is termed treatment-induced menopause.
Chemotherapy, radiotherapy, surgical removal of ovaries, and anti-oestrogen therapy are common breast cancer treatments.
Both chemotherapy and radiotherapy can damage or disrupt ovarian function.
For some women, periods can stop temporarily, and in others, they can stop permanently, resulting in permanent menopause. It can be difficult to know if your periods will start again, and you may not know for 6- 12 months.
Even if periods return, many breast cancer survivors are at an increased risk of going into complete menopause earlier than others or premature ovarian failure.
Medications like aromatase inhibitors, tamoxifen, or ovarian suppression are designed to block oestrogen's effects. These treatments can induce menopausal symptoms by creating a hormonal environment similar to menopause. Some women may regain ovarian function and experience a reversal of menopause-like symptoms after treatment concludes.
Surgery and radiotherapy to the breast don't directly cause menopause. However, surgeries like ovary removal or medications to 'turn off' the ovaries, often part of breast cancer treatment, can induce sudden and severe menopause symptoms.
For many breast cancer survivors, the path through menopause is complex and challenging.
Distinguishing Features of Breast Cancer Treatment-Induced Menopause
Menopause, whether natural or induced, brings significant changes to a woman's life. However, menopause triggered by breast cancer treatment can present unique challenges and differences compared to natural menopause. Here's a closer look at these distinctions:
1. Abrupt Onset: In natural menopause, hormonal changes occur gradually over several years. Typically, a woman's body adapts to these shifts slowly. In contrast, menopause induced by breast cancer treatment can happen suddenly. This abrupt transition involves a significant and swift drop in oestrogen levels, leading to intense and often immediate menopausal symptoms. The stark contrast in the pace of change can make treatment-induced menopause feel way more severe, and it is often more persistent.
2. Emotional Stress: Coping with a breast cancer diagnosis and the demanding treatment process is emotionally challenging. The additional burden of severe menopausal symptoms can compound this stress. Mood swings, anxiety, and feelings of overwhelm may become more pronounced in this context.
3. Symptom Attribution: When recovering from surgery or undergoing cancer treatment, distinguishing between symptoms caused by treatment and those resulting from hormone changes can be tricky. For example, fatigue, hot flushes, and mood swings can all stem from a combination of surgery, chemotherapy, radiation, and hormonal shifts. A symptom diary can help pinpoint the causes and provide evidence when discussing your experiences with healthcare providers.
4. Around 75% of breast cancers are sensitive to the hormone oestrogen, often called oestrogen receptor-positive breast cancer. This sensitivity dictates the treatment approach, as systemic hormone therapy (treatment that enters the bloodstream) may not be an option due to concerns about the impact of oestrogen on cancer growth. It's essential to understand that oestrogen itself does not cause breast cancer. Still, it plays a role in its development and progression.
Medication Options for Breast Cancer Survivors: Managing Menopausal Symptoms
In general, conventional Hormone Replacement Therapy (HRT) in the form of patches, gels, or pills is usually not recommended for managing menopausal symptoms in breast cancer survivors.
There is one notable exception to this approach when addressing symptoms related to vaginal dryness and atrophy. Initially, non-hormonal vaginal moisturisers like Replens, YES, and Regelle can offer relief. These moisturizers can be combined with lubricants during intercourse to enhance comfort and alleviate discomfort.
In specific cases where symptoms persist, low-dose oestrogen tablets such as Vagifem or Vagirux can be applied directly to the vaginal area. It's important to note that this is a localised hormone therapy with minimal general absorption, making it a safe and effective option for many women.
Ultimately, the choice of symptom relief strategy should be discussed with a healthcare provider, considering individual circumstances and medical history. There are experienced menopause consultants who collaborate with both oncologists and patients to comprehensively assess individual symptoms and medical histories.
This collaborative approach ensures that the most suitable treatment plan is identified to address the unique menopausal symptoms in breast cancer survivors.
If traditional HRT is not suitable, non-hormonal medications can be discussed with your healthcare provider. These alternatives may help alleviate menopausal symptoms:
Antidepressants: Selective serotonin re-uptake inhibitors (SSRIs) or SNRIs can be considered. They are known for their effectiveness in reducing hot flushes. It's best to start slowly and gradually increase. If you are undergoing tamoxifen treatment for breast cancer, consult your oncology team before beginning any antidepressants.
An anti-seizure drug, gabapentin or clonidine, usually used to reduce blood pressure, are non-hormonal options for managing hot flashes. These both can have an assortment of side effects.
Exploring Additional Lifestyle Choices
During the menopausal journey, it's easy to underestimate the power of lifestyle adjustments. Although individual changes may not appear overwhelmingly influential, their collective impact can be remarkably effective. Importantly, these adjustments won't disrupt your ongoing cancer treatment or survivorship strategy.
In fact, some of these changes can even contribute to your long-term well-being, which is equally significant, especially if you experience early menopause.
1. Identify Triggers: Start by pinpointing your hot flush triggers. Maintain a diary to track factors such as stress, caffeine intake, alcohol consumption, spicy foods, hot showers, smoking, and exposure to warm weather.
2. Maintain a Healthy Weight: Research indicates that maintaining a healthy body weight can lead to fewer hot flushes. Strive for a balanced weight to alleviate symptoms.
3. Quit Smoking: Both active and passive smoking can heighten the risk of hot flushes. Ceasing smoking not only benefits your overall health but also reduces menopausal symptoms.
4. Regular Exercise: Engage in moderate, regular exercise to experience fewer and shorter hot flushes, improve your mental health, and support a healthy weight. However, don't go manic. Moderation is key.
5. Manage Stress: Stress is a known trigger for hot flushes. Employ relaxation techniques such as yoga, meditation, or paced respiration (deep, abdominal breathing) to manage anxiety, which can intensify these episodes.
6. Prioritize Sleep: Aim for 7-8 hours of restorative sleep each night. Establish a consistent bedtime routine, avoid caffeine in the evening, and create a sleep-conducive environment by keeping your room completely dark and minimizing electronics usage before sleep.
7. Healthy Eating: Assess your diet for potential triggers like caffeine and spicy foods. Embrace a well-balanced diet and maintain proper hydration for symptom relief.
8. Limit Alcohol: Excessive alcohol intake can exacerbate hot flauhes and disrupt sleep. Follow guidelines for alcohol consumption (less than 5 units a week, as recommended by NICE, if you have a history of breast cancer).
9. Explore CBT (Cognitive Behavioral Therapy): CBT techniques have shown effectiveness in managing both hot flashes and insomnia, offering potential relief.
10. Phytoestrogens: Consider incorporating more phytoestrogen-rich foods into your diet, as they can be beneficial. Consult a specialist before considering supplements.
11. Stay Hydrated: Drinking water is essential to replenish fluids lost during hot flashes and night sweats and as a preventive measure against hot flushes.
12. Talking: Additionally, remember that talking to someone about your experiences can be immensely beneficial. Managing cancer and its treatment is challenging on its own. Dealing with the added burden of menopausal symptoms, especially when they are severe, can be pretty daunting. Sharing your concerns and experiences with someone who understands can make a significant difference in your well-being.
Lifestyle choices play a crucial role in the post-breast cancer treatment phase, especially when hormone replacement therapy (HRT) cannot be considered due to its potential risks.
For breast cancer survivors, proactivity in managing long-term health becomes paramount. By adopting healthy lifestyle choices, such as maintaining a healthy weight, staying physically active, managing stress, and following a balanced diet, women not only reduce their menopausal symptoms but can help reduce the risk of recurrent disease and improve overall well-being.
These choices are protective and empowering, enabling survivors to take control of their health and navigate the challenges of menopause and survivorship with resilience and strength. While the path to recovery after breast cancer may be challenging, making mindful lifestyle choices can significantly enhance the quality and longevity of life beyond cancer treatment.
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