Managing menopausal symptoms
There are several approaches that may help to reduce menopausal symptoms. Choosing which are right for you will depend on your personal preferences, the possible risks and benefits of each approach, the type and severity of your symptoms, and what other treatments you are taking.
Your symptoms may include:
Hot flushes and sweats
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This is the most common menopausal symptom. Although the exact cause is unknown, body temperature control seems to be affected by falling oestrogen levels. Hot flushes can vary from a mild feeling of warmth in the face to more severe symptoms such as drenching night sweats that affect the whole body.
Hot flushes generally last for about 4-5 minutes. During a hot flush you may feel sudden warmth in your face, neck and chest, and you may become flushed and perspire. Some women feel their heart beating faster (palpitations) during a flush.
If you have flushes at night, these may affect your sleep. Night sweats can disrupt your sleep pattern, especially if you need to change your night clothes and bedding.
It’s difficult to completely stop hot flushes and sweats, but their frequency or intensity can often be reduced. Using a combination of some of the approaches below is often most successful at controlling or reducing flushes.
Be aware of triggers
Certain situations may bring on or trigger a hot flush. For example, getting too warm, drinking tea, coffee or alcohol, or eating spicy foods. Keeping a record of when you have flushes can help you find out what triggers them, so that you can try to avoid these triggers.
Even if you don’t have obvious triggers, keeping a record can help to measure how much a treatment for hot flushes is helping.
There’s lots of practical advice available to help women cope with hot flushes. Here are a few tips:
Wear natural fabrics, such as cotton, and dress in layers, so you can remove clothes as needed.
Use cotton sheets and have layers of bedding.
Keep the room temperature cool or use a fan.
Have cold drinks rather than hot ones
Try some complementary therapies, such as controlled breathing, yoga, etc.
There are different medicines that your doctor can prescribe to help reduce the severity and frequency of your hot flushes and sweats:
Antidepressants such as venlafaxine, paroxetine and fluoxetine may reduce the frequency and severity of hot flushes by about 50% (half) in some women. It generally takes 1-4 weeks for antidepressants to reduce hot flushes. Side effects of antidepressants can include headaches, feeling sick, reduced appetite, a dry mouth and constipation.
Paroxetine and fluoxetine aren't recommended for women taking tamoxifen, as they may interfere with its effectiveness. However, venlafaxine doesn't interact with tamoxifen so can be taken with it.
This is an anti-epilepsy drug that has been shown to be effective at reducing hot flush severity and frequency. Possible side effects include feeling very tired, drowsiness and dizziness.
Clonidine (Catapres®, Dixarit®)
Clonidine is a drug used to treat high blood pressure or migraines and can help reduce hot flushes and sweats in some women. It can take four weeks to work. Side effects can include constipation, a dry mouth and drowsiness.
Hormone replacement treatment (HRT)
Hormone replacement therapy replaces the hormones no longer being produced by the ovaries and can relieve symptoms such as hot flushes.
However, HRT isn’t recommended after breast cancer treatment because it contains oestrogen, which may increase the risk of the cancer coming back. Breast cancer guidelines do not recommend non-oestrogen types of HRT, such as Tibolone (Livial®) or low dose progestogens (megestrol acetate, norethisterone and medroxyprogesterone acetate) either.
Rarely, if a woman’s symptoms are severe and nothing else helps, HRT may be prescribed. This is only done after careful discussion with your cancer specialist to make sure you understand the possible risks as well as the benefits.
Having a low level of oestrogen can cause vaginal dryness and itching, and make having sex uncomfortable or painful. Some creams can be helpful when applied directly to the vagina (topical treatment).
Your doctor can tell you which product is most suitable for you. Your treatment should be regularly reviewed by your doctor, and you should tell them about any new symptoms. Some creams may damage condoms and diaphragms, so you may need to use another form of contraception to avoid pregnancy.
Replens MD® is a non-hormonal cream that you apply 2-3 times a week. The cream binds to the vaginal wall and helps rehydrate cells. It boosts blood flow in the vagina. Hyalofemme® is a newer cream that can be applied daily.
Water-based lubricants such as Senselle®, KY-Jelly®, Astroglide® and Sylk® can help reduce discomfort from vaginal dryness during sex.
Some treatments contain a small amount of oestrogen. The long-term risks of using products containing oestrogen after breast cancer are unknown. However, some breast specialists think very little of the oestrogen is absorbed and may prescribe some of these treatments for short periods of time.
Vagifem® is a tablet that you insert into the vagina (a pessary). You normally use it daily for two weeks, and then reduce the dosage to twice a week. Vagifem can increase the amount of oestrogen circulating in the body so isn’t usually recommended for women who are taking aromatase inhibitors. Your breast specialist or breast care nurse can give you further advice and information about this.
Ovestin® and Ortho-Gynest® can reduce dryness and itching for a short time. They're available as creams and pessaries. They contain a small amount of oestrogen.
Estring® is a vaginal ring that's worn for three months. It slowly releases a small amount of oestrogen and may help reduce dryness.
A lower sex drive is a symptom of the menopause. HRT is usually the most effective treatment for this but isn’t usually recommended in women who’ve had breast cancer. A lower sex drive can also happen as a result of coping with the cancer and its treatments.
Other menopausal symptoms such as hot flushes and vaginal dryness can also reduce your interest in sex. Treating these may help to improve your sex life. Talk to your doctor or specialist nurse if you are having sexual problems as there may be treatments that can help, or they may be able to refer you to a sex therapist or counsellor. Our section on cancer and sexuality has more information.
Passing urine more often
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You may pass urine more often, have some urine leakage or be more prone to urinary tract infections.
It's important to drink enough fluid each day (at least 2-3 pints/1.5 litres) to keep your bladder healthy. If you don’t drink enough, your urine will become concentrated and irritate the bladder. You'll also be more likely to develop urinary tract infections.
If you have problems with urine leakage, doing regular pelvic floor exercises (Kegel exercises) can help. These exercises strengthen the muscles that hold urine in the bladder. Your nurse or doctor can explain how to do these exercises, or you can order an instruction leaflet from the Bladder and Bowel Foundation.
Speak to your doctor if you develop symptoms of a urinary tract infection. Symptoms include cloudy or smelly urine, and pain or discomfort when passing urine.
You may have difficulty sleeping because of hot flushes, sweats or anxiety. The following suggestions may help you to relax and sleep well:
A warm drink, brushing your teeth or reading in bed for a while can let your brain know that it’s time to sleep.
Sleep for the right amount of time without oversleeping - too much time in bed can affect the quality of your sleep. Also, wake up and go to bed at the same time each day.
Get out of bed if you can’t sleep, and try reading, or listening to some soothing music. Wait until you feel tired again, and then go back to bed.
Breathing exercises and relaxation techniques, or listening to relaxation CDs, tapes or podcasts, can help reduce anxiety and sleeplessness. Your GP can prescribe sleeping tablets for a short period of time - these may help you re-establish a sleep pattern.
The psychological effects of menopausal symptoms can be hard to cope with when you already have to deal with cancer.
These effects can include mood swings, a lack of confidence, and a loss of concentration and memory. At times you may feel very emotional or anxious.
Many women find it helpful to talk through their feelings with family and friends, or their doctor or nurse. A number of organisations provide support to women going through the menopause. Some women may find counselling helpful. Your doctor or nurse can give you more advice.