Menopausal symptoms after breast cancer treatment
Some treatments for breast cancer can affect the way the ovaries work. As a result, you may start your menopause earlier than expected, or have menopausal symptoms due to the treatment itself.
Diane talks about her experiences of breast cancer treatments and how she coped with menopausal symptoms.
The menopause happens because the ovaries stop producing the hormones oestrogen and progesterone. Women naturally stop having regular periods, usually at some time between their mid-40s and mid-50s.
Women who’ve had chemotherapy close to the age of natural menopause (around 50) may go into the menopause abruptly. Younger women in their 30s may find that their periods stop for a while and then come back again. However, they may have an earlier menopause than usual.
Women taking tamoxifen or hormonal drugs called aromatase inhibitors, such as anastrozole (Arimidex®), letrozole (Femara®) and exemestane (Aromasin®), may have side effects that are similar to menopausal symptoms.
Coping with early menopause or menopausal symptoms when you’re already dealing with cancer can be very difficult. You may have other troublesome treatment side effects to cope with too. There are different approaches that may help you to cope or to reduce menopausal symptoms.
Choosing the right approach for you will depend on different factors and your preferences. This includes the possible risks and benefits of each approach, the type and severity of your symptoms and other treatments that you may be taking.
You may have one or more of the following symptoms, which can range from mild to more severe. Our section on breast cancer and menopausal symptoms has more detailed information.
Hot flushes and sweats
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This is the most common menopausal symptom. Hot flushes can vary from a mild feeling of warmth in the face to a drenching night sweat. Flushes and night sweats can be particularly disruptive to your sleep pattern.
It’s difficult to stop hot flushes and sweats, but their frequency or intensity can often be reduced. Using a combination of approaches is often most successful at controlling or reducing flushes. Getting too warm, drinking tea, coffee or alcohol, or eating certain foods, may bring on a hot flush. Keep a record of when you have flushes to find out which things trigger them, so you can try to avoid them.
Here are some suggestions for ways to manage hot flushes:
Cooling your body when you feel a flush coming on may help. Try drinking cold water. You can also try storing cold packs in the freezer to use when you feel the need.
Some people find a special pillow called a Chillow®, which acts as a cooling pad, helps them to sleep better.
Slow, controlled breathing techniques have been shown to help some women.
Ask your doctor about cognitive behavioural therapy, which is a type of therapy that teaches techniques and strategies to help you deal with difficult emotions and situations.
Have a lukewarm bath to relax before bedtime.
A warm herbal or milk drink before bed can help you to relax.
Wear clothes made of natural fibres such as cotton, silk or linen. Layers mean you can adjust your temperature more easily.
If you smoke, giving up may help reduce hot flushes.
Try doing regular aerobic exercise, such as walking or jogging.
Relaxation or meditation tapes/CDs/podcasts, relaxation exercises, visualisation, massage or meditation can help to reduce anxiety and sleeplessness. See our page on mind-body therapies for more about these techniques. Your GP can prescribe sleeping tablets for a short period of time to help re-establish a sleep pattern.
Low doses of antidepressants such as paroxetine, fluoxetine and venlafaxine may reduce the number and severity of hot flushes by about half (50%) in some women. 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 they can be taken together.
An anti-epilepsy drug called gabapentin has also been shown to be effective at reducing the severity and frequency of hot flushes.
Megestrol acetate is also effective in treating hot flushes, but some doctors have concerns about using it because it contains progestogen, which is similar to the female hormone progesterone.
Clonidine is a medicine used to treat high blood pressure or migraines, which may help to reduce hot flushes and sweats in some women.
Hormone replacement therapy (HRT) isn’t recommended after breast cancer because it increases the risk of the cancer coming back or of a new breast cancer developing. Tibolone, a different type of HRT, should also be avoided. Although it doesn’t contain oestrogen, it increases the risk of breast cancer coming back.
Some doctors may prescribe HRT if a woman’s symptoms are very severe and nothing else helps. It’s important to talk this through with your cancer specialist to make sure that you are clear about the possible risks and benefits. The risks of HRT are lower for women who’ve had oestrogen-receptor negative (ER negative) breast cancer.
Complementary therapies for hot flushes
Some women find that complementary therapies help reduce hot flushes. There are different types that may be used.
Acupuncture is the practice of putting sterile needles through the skin at specific points in the body. There’s some research evidence that it may help to reduce the number and severity of hot flushes. Hypnosis may help to reduce the length and severity of hot flushes, but it’s unlikely to be available on the NHS.
Several studies have shown that using a slow, controlled breathing technique called paced breathing can be an effective way of managing flushes. There’s also a yoga breathing technique, known as the ‘cooling breath’ or sheetali that can help to reduce your body temperature.
A recent study found that women who used paced breathing in combination with cognitive behavioural therapy (CBT) reduced the number of hot flushes they had by almost half (40%).
One study found that taking vitamin E supplements helped to reduce hot flushes by a small amount for some women. Evening primrose oil is used by some women but there’s no scientific evidence that it works for reducing menopausal symptoms.
Plant oestrogens (phytoestrogens) can have a weak oestrogen-like effect, but there’s no evidence they improve menopausal symptoms. There is also concern that they may increase the risk of breast cancer coming back. Recent breast cancer treatment guidelines recommend that women who have had breast cancer don’t take plant oestrogens, such as black cohosh or red clover, to treat menopausal symptoms.
Homeopathy uses tiny amounts of substances that would normally produce the symptoms being treated. Although it may be used by some women, there’s no scientific proof that it works.
Lower oestrogen levels can cause changes in the lining of the vagina, making it drier, less stretchy and more fragile. This can cause vaginal discomfort or pain in some women.
Using vaginal creams or lubricants can help. Replens MD® is a non-hormonal cream that you apply 2-3 times a week. It boosts blood flow in the vagina. Water-based lubricants, such as Senselle®, Astroglide® and Sylk®, can help to reduce discomfort from vaginal dryness during sex. You may need to try more than one of these products to find which works best for you. They are sold in chemists and on the internet.
There are also some treatments that release a small amount of oestrogen into the vagina, which helps to restore some lubrication and stretchiness (elasticity):
Vagifem® is a tablet that you insert into the vagina (a pessary).
Ovestin® and Ortho-Gynest® are available as creams or pessaries.
Estring® is a vaginal ring that is worn for three months.
The long-term risks of using products containing oestrogen after breast cancer aren’t known. However, many breast specialists think that very little of the oestrogen in the creams and pessaries is absorbed by the body. If they’re prescribed for you, they should be used in the lowest possible dose.
It’s important to talk to your specialist or breast care nurse before you use any products containing oestrogen.
Passing urine more often
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You may pass urine more often, have some urine leakage or be more prone to urinary infections. It’s important to drink enough fluid (at least 2-3 pints/1.5 litres) each day to keep your bladder healthy. If you don’t drink enough, your urine will become concentrated and irritate the bladder. You will also be more likely to develop urinary infections.
Speak to your doctor if you develop symptoms of a urinary infection such as:
pain or discomfort when passing urine
urine that smells bad.
There are different causes for urine leakage. If you have this problem, you should speak to your GP.
Sometimes pelvic floor exercises (also called Kegel exercises) can help. These exercises strengthen the muscles that hold urine in the bladder. Your nurse or doctor can explain to you how to do these exercises or you can order an instruction leaflet from the Bladder and Bowel Foundation.
Vaginal treatments containing low doses of oestrogen can improve urinary problems and reduce urinary infections.
The psychological effects of menopausal symptoms can be hard to cope with when you already have to deal with the physical effects of cancer. Psychological effects can include a lower sex drive, mood swings, lack of confidence and a loss of concentration and memory.
You may feel emotional or anxious without really knowing why. A number of organisations, including The Daisy Network, provide support to women going through the menopause. Many women find it helpful to talk through their feelings with their doctor or nurse, or with family and friends. You may also find it helps to speak to a professional counsellor.