Breast Cancer and Menopause

Menopause is the cessation of menstruation for a year or more. Perimenopause is the time just before natural menopause. Symptoms can occur for several years before your period actually stops.Common symptoms of transition to menopause include hot flashes and night sweats, mild anxiety and depression, reduction of sex drive, vaginal dryness, and the risk of osteoporosis or bone thinning. Common remedies for menopausal symptoms target estrogen receptors.

Because of the link between estrogen and breast cancer, it is important for all women, and especially women who have breast cancer, to talk to your doctor about any remedy they may wish to try.

Is hormone replacement therapy safe?

It was once thought that hormone replacement therapy, or HRT, for women in menopause had many health benefits. After the federally funded Women's Health Initiative released the startling data that the risks outweighed the benefits for most women, HRT was no longer recommended so broadly. For women who've had breast cancer, the risks of HRT are even higher. Even the safe use of progestins only (without estrogen) has been questioned in breast cancer survivors. At this time, the recommendation is to avoid supplementation with both estrogen and progestin after breast cancer.

What medicine treats hot flashes?

Hot flashes are apparently worse for women treated for breast cancer. Ask your doctor about non-hormonal medical relief, including transdermal clonidine, antidepressants such as paroxetine, and gabapentin.

Clonidine can reduce hot flashes by 40%. This medication is used in lower doses to treat migraines and in higher doses to treat high blood pressure. There are some bothersome side effects. It can be taken in pill form or as a skin patch.

Gabapentin, known as NeurontinÒ, works on the central nervous system for a variety of problems and helps with hot flashes. Some of the newer antidepressants have shown a helpful effect, including venlafaxine (Effexor) and paroxetine (Paxil). You and your doctor will need to weigh the risks and the benefits of all of these medications.

Are there any natural remedies for hot flashes?

One natural remedy that might have an effect is black cohosh, which was both safe and effective in German studies. However, these were very small studies on women who had not had cancer. Other remedies women turn to for relief of hot flashes include evening primrose, soy products, don quai (a Chinese herb), and vitamin E. The effects of any herbal supplement in women with a history of breast cancer have not been established. It is important that you talk to your doctor before using an herbal product.

You may be sleeping poorly overall so it might help to keep a daily log of those times when the hot flashes are worse and see, what preceded it. If you have nighttime hot flashes, do they worsen when you've had wine for dinner? Also stay well hydrated during the day and avoid stimulating TV or other activity just before bedtime. You may also want to your thermostat down at night.

Some women have more hot flashes when they are stressed. Take steps to reduce your reactivity to stress in your life. Regular exercise helps to promote healthy sleep and lowered anxiety as well.

What helps vaginal dryness?

Vaginal dryness can be relieved by a vaginal ring called EstringÒ that slowly releases estrogen. It's worn inside the vagina similar to a diaphragm. It's considered safe because of the low and very localized release of estrogen. Other vaginal lubricants, such as ReplensÒ, moisturize the vagina without estrogen. VagifemÒ tablets and PremarinÒ vaginal cream are also available by prescription.

What would help my mood swings?

Exercise has been shown to lower the perception of stress and help with the restoration of stamina after treatment and the relief of mild depression and anxiety.

Talk therapy might also help you cope with mood swings. You've been through a lot; you're juggling a great deal physically and emotionally. Finding a therapist or support group might help you as you enter a new chapter in your life.

Some women find that keeping a journal is useful for dealing with emotions. Taking up meditation or using guided imagery helps as well.

There are also a number of antidepressants that are very effective and that may also help with mood swings.

Will my period return?

The younger you are, the more likely it is your period will resume. Also, the chances that your period will resume are higher if you had AdriamycinÒ (also called doxorubicin) instead of methotrexate or epirubicin, and intravenous CytoxanÒ rather than the pill form.

If you were beginning to approach menopause, it is much less likely that your periods will return. Even with the resumption of your periods, fertility is not assured. If your periods begin again, it is likely that menopause will come sooner than it would have if you'd not had chemotherapy. If after 6 to 12 months menstruation has not come back, then the likelihood of menopause is higher. Some women do not menstruate for 1 to 2 years after chemotherapy; when their periods return, they find that they may not menstruate as long or as heavily as they would have before chemotherapy.

Will eating soy help with hot flashes?

Several studies have looked at the efficacy of soy products on relieving hot flashes of menopause. The results have been mixed.

More important, since there is no clear research showing that soy is safe for breast cancer patients, the general recommendation is to avoid supplementing your diet with large quantities of soy or its components, called isoflavones. Soy acts like an estrogen in the body, which means it might increase the risk of breast cancer recurrence.

The American Heart Association, or AHA, released a review of the research on the health effects of soy. It noted that the results were mixed on whether soy prevented postmenopausal bone loss that can lead to osteoporosis. Based on its findings, the AHA said it would not recommend using isoflavone supplements. However, the AHA did mention that soy products could be heart-healthy because they contain polyunsaturated fats, fiber, and vitamins and minerals and are low in saturated fat. Eating soy nuts, soy beans, and tofu in moderation can be good for your heart.

What about osteoporosis?

To maintain the best bone health possible, get weight-bearing exercise regularly and make sure you have enough calcium and vitamin D in your diet. If your doctor recommends it, you can add a supplement to your diet. Consider taking the following steps:

• Ask your doctor about safe weight-bearing exercise.

• Ask your doctor about a referral to a physical therapist for a fitness assessment and exercise plan.

• Ask about a bone density scan.

• Ask about a calcium supplement.