Young women diagnosed with breast cancer are usually treated with chemotherapy, which can affect ovarian function and cause infertility. In many cases this effect is temporary, with periods and fertility returning after the completion of treatment, but in some women the treatment causes premature menopause. Women over 40 have a higher risk of early menopause after chemotherapy than younger women.
Younger women with regular periods before treatment are likely to experience more pronounced side effects of oestrogen deficiency with the onset of premature menopause, because they undergo a more significant change in oestrogen levels. Older women, in contrast, might experience a smaller change because they’re often already experiencing a natural decline in ovarian function.
Menopausal symptoms may include hot flushes and night sweats, disrupted sleep, mood swings, vaginal dryness/sensitivity, and in some cases mild/moderate depression or anxiety. Your medical team will be able to help with managing menopausal side effects, and it’s important to discuss this with them.
Menopausal symptoms can impact your quality of life, so letting your doctors know if things become unbearable is important for your wellbeing – especially as your treatments for breast cancer may go on for some time.
Management of menopausal symptoms
Many of the symptoms of menopause can be helped by lifestyle modifications.
Hot flushes and night sweats
The number and intensity of hot flushes and night sweats can be significantly reduced with regular exercise and maintaining a healthy weight. Acupuncture might provide a degree of relief for some women. It’s also useful to try and identify any triggers which regularly set off hot flushes and try to avoid them. Triggers will be different for everyone, but commonly include hot or spicy food, alcohol, smoking, caffeinated drinks, stress, or being in a hot room.
There is no evidence that medications such as Black Cohosh, Vitamin E, Ginseng and progesterone cream reduce flushes and the safety of these measures in breast cancer is unclear.
To minimize the effects of hot flushes, you could dress in layers which can be removed when you feel a flush starting, or carry a fan, sip iced water or dress in cotton and natural fibres.
For night sweats, you could keep an ice pack by your bed at night and use cotton sheets.
SSRIs and other medications
If the number of flushes/sweats you are experiencing is having a significant effect on your life you may find it helpful to talk to your doctor about non-hormonal medications which could improve your situation.
Selected Seratonin Re-uptake Inhibitors (SSRIs) are commonly used to treat hot flushes and sweats. They are also antidepressants but trials have shown they reduce hot flushes/sweats for about 70% of women who take them. Citaloprim and Venlafaxine are considered to be safe in women taking tamoxifen.
Other medications such as Gabapentin and Clonidine help reduce flushes in some women. Amitriptylline helps improve sleep although it doesn’t actually reduce the number of night sweats. If flushes/sweats are severely impacting on your life, talk to your doctor about whether there are medications which might be appropriate for you.
Vaginal dryness is a natural consequence of oestrogen deprivation, but can be effectively managed with moisturizing vaginal gels, and the use of lubricants during sexual activity. Replens is a long lasting moisturizer that, when used regularly, helps to hydrate vaginal tissue. It’s available from selected pharmacies.
For sexual activity, avoid lubricants which contain petroleum products as they can worsen the problem. Water-based lubricants are available and are less irritating to the tissues.
In very severe cases which have not responded to non-hormonal interventions, treatment with low dose vaginal oestrogen could be considered, in discussion with your oncologist, as systemic absorptions from these products is considered to be low. This is not suitable for anyone taking aromatase inhibitors.
Premature menopause can also affect your bone density, as oestrogen is needed for maintaining strong bones. Osteoporosis is a disorder in which the bones become increasingly porous and brittle, due to loss of calcium and other mineral components. It is a natural result of ageing, but can also be induced and/or accelerated by the oestrogen-reducing treatments for breast cancer. Osteoporosis increases your risk of fractures, so it’s important to try to maintain your bone health.
Having a benchmark bone density scan prior to the start of some breast cancer treatments, and follow up scans at prescribed intervals, may be recommended for some women. These scans measure the "thickness" of your bones and can predict future fracture risk, enabling your medical team to keep an eye on any changes in your bone density as you progress through your treatment plan. Bone thinning is a gradual process over years, and may or may not be an issue for you. However, it’s good to discuss this with your doctors and review the short and long-term impact of treatment on your bone health.
You can try to maintain your bone health with some easy lifestyle measures:
- Ensure you get enough calcium
Calcium helps build stronger bones. Two servings a day of dairy products should maintain an adequate level of calcium in the body for most people.There is no evidence that using calcium supplements adds any benefit for bone density and there are some concerns about the safety of these, so ensuring you get adequate calcium through your diet is preferred.
- Ensure you get enough Vitamin D
Vitamin D aids the absorption of calcium and is produced in the body when skin is exposed to sunlight. Most active, healthy people will have adequate levels of Vitamin D but people with dark skin or those who are veiled or don’t go outside may benefit from a supplement.
- Do regular weight-bearing exercise
Regular weight-bearing exercise such as jogging, walking, or tennis strengthens bones. Low-impact exercise such as swimming and cycling strengthens muscles but doesn’t improve bone density.
- Maintain a healthy weight
Underweight women have a higher risk of developing osteoporosis than those with more body weight and larger frames.
- Limit alcohol and don’t smoke
Heavy alcohol intake and smoking are both associated with an increased risk for osteoporosis.
The Osteoporosis New Zealand website has some great information about bone health.