Women's Wellness: Dr. Stephanie Faubion discusses menopausal symptoms and nonhormonal therapies
How to Manage Menopausal Symptoms After Breast Cancer
The diagnosis and treatment of breast cancer can have a profound impact on anyone's life. But one thing many young women might not be prepared for is menopause.
By Sheryl Kraft
Medically Reviewed by Thomas Marron, MD, PhD
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If you’re being treated with chemotherapy for breast cancer, it’s not uncommon to experience transient menopause symptoms like hot flashes and irregular or absent periods. The younger you are, the more likely that these symptoms will be temporary, and that your periods will return — usually within a year of finishing treatment, according to Breastcancer.org.
But that’s not always the case. Sometimes chemotherapy throws you into permanent menopause. Anti-estrogen medications used after the treatment of some breast cancers can perpetuate or worsen these symptoms, and these therapies are now typically given for 10 years or longer after chemotherapy is complete.
While the average age of menopause in the United States is 51, it can come much earlier for premenopausal women treated with chemotherapy for breast cancer.
That’s because some drugs used in chemotherapy regimens, which work by destroying rapidly dividing cells, can damage the ovaries — the organs that produce eggs in a process of rapid cell division.
The transition can be a shock. Most women going through a natural menopause will do so gradually, and their bodies have time to adjust. “There are at least several years of wide swings in estrogen levels, both high and low, prior to the final menstrual period,” says Cynthia Stuenkel, MD, a clinical professor of medicine at the University of California in San Diego and one of the authors of the study cited above. Normally, this process lasts anywhere from four to eight years.
But for younger women, whose bodies are accustomed to higher levels of estrogen, chemotherapy can cause hormone levels to plummet abruptly, says Dr. Stuenkel.
The result? More intense menopausal symptoms, such as hot flashes, sleep disturbance, difficulty concentrating, muscular and joint pain, irritability, and vaginal dryness. Most women are “not psychologically prepared” for this rapid change, says Courtney Hennelly, a nurse practitioner at Memorial Sloan Kettering Cancer Center in New York City.
Indeed, a study published in June 2013 in theJournal of ThoracicDisease found that not only were the physical symptoms in these women more severe, they were more likely to suffer from depression and other mental health issues as a result of the premature transition.
Hormone replacement therapy is one viable option for treating menopausal symptoms, but most experts advise against its use for women with a history of breast cancer, out of concern that the added estrogen could fuel the growth of lingering cancer cells, says Stuenkel.
Meanwhile there are some safer, nonhormonal ways to manage menopausal symptoms. A comprehensive review of recommendations for managing menopausal symptoms in breast cancer appeared in the August 2019 issue of the Journal of Clinical Endocrinology & Metabolism and emphasized a variety of broad lifestyle-related strategies for addressing symptoms, including smoking cessation, weight loss for those who are overweight, limiting or avoiding alcohol, consuming adequate calcium and vitamin D, and regular physical activity.
Other recommendations for specific symptoms include:
For Moods, Sleep Disturbances, and Hot Flashes
Fluctuating hormone levels can create feelings of being out of control, may disturb your ability to fall or stay asleep, and may mess with your inner thermostat.
- If you’re overweight, losing weight may help ease hot flashes and help improve the quality of your sleep, says Hennelly.
- The review article above found evidence supporting the use of cognitive behavioral therapy, hypnosis, and acupuncture for hot flashes.
For Vaginal Symptoms
Lower estrogen due to menopause can result in a thinning of the lining of the vagina. This can cause decreased lubrication and painful sex, and lead to redness, dryness, irritation, burning and itching.
- Water-soluble lubricants, like Astroglide or K-Y Jelly, can help relieve painful intercourse.
- Avoid perfumed soaps and toilet tissue, fabric softeners, bubble baths, douches and vaginal deodorants, and synthetic undergarments (opt for cotton instead).
Low-dose vaginal estrogen can be very effective, but experts generally recommend nonhormonal treatments as a first-line approach, especially since some breast cancers are estrogen-dependent. In March of 2019, the American Congress of Obstetricians and Gynecologists issued a statement saying that the research thus far didn’t show any worsening of disease or increased risk of recurrence in women undergoing treatment for breast cancer or those with a history of it. But experts are still cautious and will recommend the lowest dose possible.
Video: Breasts changes during menopause
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