Coping With Menopausal Symptoms After Breast Cancer Treatment
Menopausal symptoms caused by breast cancer treatment can be challenging for anyone of any age. They are a common side effect of many types of chemotherapy treatment as well as surgery to remove the ovaries and hormonal therapy medicines.
Simply speaking, menopausal symptoms such as hot flashes, night sweats and vaginal dryness occur when the ovaries no longer make normal levels of estrogen. Many breast cancer treatments can affect menopausal symptoms.
Janet S. Carpenter, PhD, RN, FAAN, director of the Center for Enhancing Quality of Life in Chronic Illness at Indiana University, says women can experience a variety of menopausal symptoms and related health problems. These include:
- Hot flashes
- Night sweats
- Sleep troubles
- Mood swings
- Bone loss
- Changes in sexual desire
- Problems with vaginal dryness
Menopausal symptoms vary by person and in strength, and what bothers one person might not bother another. Wendie Pahor, 49, of Las Vegas, Nevada, was diagnosed with stage I breast cancer in January 2011.
“I experienced hot flashes, night sweats, vaginal dryness, total lack of [sexual] desire, painful intercourse and weight gain,” Wendie says. “I can handle the hot flashes and such, but the [impact on] intimacy with my husband is what has affected our quality of life the most.”
Changes in estrogen levels can disrupt your comfort during sex. “The vagina has more estrogen receptors per square inch than probably anywhere else in the body,” says Ann Honebrink, MD, a gynecologist at Penn Health for Women at Radnor of the University of Pennsylvania School of Medicine. “When breast cancer treatment deprives the body of estrogen, the walls of the vagina thin, the opening narrows, and combined, this causes discomfort that’s very noticeable.”
A health issue often related to loss of estrogen and menopause is bone loss. Osteopenia, or lower than normal bone density, occurs naturally as women age. When treatment causes early menopause, the drop in estrogen can make it happen faster.
Understanding what causes menopausal symptoms and related health concerns may help you find ways to combat their effects—and to talk with your providers about actions you can take.
Natural vs. Medical Menopause
It’s important to remember that experiencing menopausal symptoms and being in menopause are different. Menopausal symptoms after breast cancer treatment can be temporary.
“We don’t say someone is in menopause until they’ve gone a year without a menstrual period,” says Patricia Ganz, MD, director of cancer prevention and control research and of the patients and survivors program area at UCLA’s Jonsson Comprehensive Cancer Center.
Natural menopause is a much more gradual process than medical menopause. “The average age of natural menopause is 51,” Dr. Ganz says. “In the 5 to 10 years preceding that when ovulation tapers off, a woman may notice hot flashes, sweating and irritability from time to time, but it’s very gradual. Women will typically experience a 2–3 year period where the intensity of symptoms pick up, around the time of the last menstrual period, as the body gets acclimated to the changes in hormone levels.”
Medical menopause, on the other hand, is sudden, may be permanent, and its symptoms can be more severe than natural menopause. In breast cancer treatment, medical menopause is caused by some anticancer therapies that damage or remove the ovaries, stopping estrogen production.
Impact of Medicines
Chemotherapy can cause menopausal symptoms as soon as the first treatment cycle, but it’s also possible to develop them later in treatment. Your periods may suddenly stop or become irregular. Either way, the estrogen levels in your body may or may not be low, and symptoms like hot flashes and night sweats can vary.
Hormonal therapies that interfere with the body’s estrogen can have the same effects. Menopausal symptoms from chemotherapy and hormonal therapy can also permanently or temporarily affect fertility in younger women.
“It’s tricky for younger women who may want to get pregnant or want to utilize some form of birth control,” says Dr. Honebrink. “Keep in mind that [treatment] doesn’t go on forever, and ovarian function may or may not return. It’s hard to predict.”
“I was having them almost 24 hours a day, feeling nauseous and almost flu-like,” Stephanie says. Her oncologist suggested integrative therapies, nonmedical therapies used alongside cancer treatment. “For now,” Stephanie says. “It is under control.”
Your doctor might offer standard medical therapies. These include gabapentin (Neurontin), an anti-seizure medicine that has been shown in studies to reduce hot flashes, and the antidepressant medication venlafaxine (Effexor). You can take practical steps, such as avoiding spicy foods and drinks with caffeine that may trigger hot flashes. Some women have success using acupuncture or deep breathing.
Stephanie also focuses on things she loves. “I have a great job and am able to work, I have four Chihuahuas I adore, and very often, I listen to music. [There’s] nothing better than spring time, opening the windows and blaring Madame Butterfly… Hang in there, it does get better,” she says.
Surgery and Ovarian Suppression
If you are premenopausal and have estrogen receptor-positive breast cancer, or you test positive for a BRCA1 or BRCA2 mutation, your doctor may recommend surgery to remove your ovaries, called oophorectomy. This causes surgical menopause, permanent menopause that begins immediately after surgery. With surgical menopause, symptoms may start suddenly, and may be more severe than those from natural menopause.
Susan Rosen, 50, of Franklin, Massachusetts, was diagnosed with stage III breast cancer in 2010. She tested positive for a BRCA2 mutation, so she had her ovaries removed.
“Surgery truly causes forced menopause—it ends your periods for good,” Susan says. “I was at an age where I was done having children. Even though I am not on any hormone therapy [medicines] at the moment, I continue to have hot flashes.”
Ovarian suppression is a possible alternative to surgery. These medicines stop the ovaries from making estrogen, which causes temporary menopause. It can cause the same menopausal symptoms as other treatments but allows you to keep your ovaries.
What You Can Do
There are many different ways to manage menopausal symptoms and find some relief. You may need or want to try several things to address your concerns.
“It may be comforting to know that hot flashes and night sweats will [often] go away on their own—and to keep in mind that however long they do last, they won’t last forever,” says Dr. Honebrink. In the meantime, she suggests:
- dressing in layers you can quickly remove to cool down
- avoiding hot drinks, smoking, spicy food, caffeine and alcohol
- asking your doctors about low doses of certain antidepressants. They may be helpful if symptoms are severe
Sexual Side Effects
For vaginal dryness, Dr. Honebrink suggests using a water-soluble lubricant during sex. Avoid those that affect sensation or contain spermicide—they can irritate the skin. Also stay away from petroleum jelly-based products that can harbor bacteria in your vagina and lead to infection. Consider regular, ongoing use of a vaginal moisturizer 2–3 times a week.
It’s common to be less interested in sex during and after treatment for breast cancer. If you find your desire for sex waning, talking with your partner about your concerns can be very helpful.
Cheryl Clark, 66, of Lake City, Florida, was diagnosed in 2010 with stage I, HER2-positive breast cancer.
“No matter how understanding or supportive a partner is, they have needs. Be creative. Communicate. Engage their help,” Cheryl says.
Wendie agrees and adds, “You need to find other ways to be intimate, such as cuddling, back rubs [and] holding hands.”
For many more tips on improving your sexual health and talking with a partner or future partners, download our Guide to Understanding Intimacy and Sexuality.
Bone loss can happen during natural or medical menopause. In some cases your doctors might order a DEXA scan, a test to measure your bone mineral density, before you start certain treatments. Your vitamin D level may also be checked.
Dr. Honebrink also suggests several methods to slow or prevent bone loss:
- perform weight-bearing exercise and eat foods rich in calcium
- consider trying foods like bok choy, broccoli, collard greens, salmon, sardines and anchovies
- find out if taking vitamin D or calcium supplements is safe for you. Too much of either could have negative effects, like kidney stones
Your doctors should tell you if tests show you have osteoporosis, a very low level of bone density. They would offer prescription medicines called bisphosphonates to treat it and lessen your risk for bone breaks.