INDUCED MENOPAUSE AFTER BREAST CANCER TREATMENTS

If you’re a young woman, menopause is probably the last thing on your mind.

Menopause is not a disease, it is a normal physiological event, the natural end of ovarian function, ovulation, periods, and fertility. All women go through menopause; the average age in North America is 51 years.

But some women with breast cancer may go through menopause earlier. Certain chemotherapies and radiation treatments can damage the ovaries and cause induced menopause. And medications used to treat and prevent breast cancer (tamoxifen and aromatase inhibitors) further decrease estrogen levels.

Do you remember puberty? How you changed as your body started producing sexual hormones like estrogen, progesterone, and testosterone?  You started growing breasts, got your first menstrual period, got hips, and many a moody day perhaps? Some say that menopause is puberty in reverse.

Estrogen is the predominant female sexual hormone – it has an effect in many cells, tissues, and organs. When it decreases rapidly, as in induced menopause, you may notice changes and symptoms that are bothersome to varying degrees.

What symptoms?

You may not experience all of the symptoms below, and definitely not all at the same time. They may also change and come and go. But many women report:

• Vasomotor symptoms (VMS) – hot flashes and night sweats (hot flashes that happen during sleep)
• Brain fog (memory and concentration changes)
• Changes in metabolism and fat distribution – weight gain and change in body-shape
• Difficulty sleeping
• Fatigue and lack of energy
• Headache
• Dry, itchy, crawling skin
• Mood swings
• Irritability
• Sadness and tearfulness
• Depressed mood
• Anxiety and worry
• Decreased self-esteem and self-confidence
• Self-doubt
• Panic
• Palpitations
• Anger
• Vaginal dryness, discomfort and pain with sex, itching, burning, soreness, urinary problems such as incontinence and urinary tract infections (UTIs), and decreased sex drive. This constellation of symptoms is called the Genitourinary Syndrome of Menopause (GSM).

These GSM symptoms are very common but are often underreported, underdiagnosed, and undertreated. Up to 80% of women may suffer from these symptoms but only 4% get treatment. There are several reasons for this, including the fact that physicians do not ask women about their vaginal and sexual health, and women do not ask their healthcare providers for help to deal with these issues. If you are experiencing symptoms of GSM you should seek help because there are several easy-to-use, inexpensive, and readily-available treatments. First-line therapies include lubricants and moisturizers; you may have to try a few before finding one that doesn’t cause irritation and stinging. If these products don’t help, or stop working, consult your OB/GYN and your oncologist to determine if low-dose estrogen applied locally to the vagina and/or vulva is an appropriate option for you and your symptoms.

Treatment for Induced Menopause

You may require treatment for menopause-related symptoms. But if your breast cancer was estrogen-sensitive then you may not be a candidate for menopause hormone therapy (MHT)—sometimes called hormone replacement therapy (HRT)—which is the most effective treatment for menopause symptoms. However, there are non-hormone treatments such as cognitive behaviour therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), gabapentinoids, oxybutynin, complementary alternative medicine (herbals), and supplements that may be helpful.

Estrogen has a protective effect on the heart, bones, and brain. When estrogen levels fall you’re at increased risk of diseases such as osteoporosis, heart attacks, strokes, and dementia. So, it’s important to live a healthy lifestyle to reduce your risk of these diseases. Eat a healthy diet, engage in regular exercise (at least 5 days a week, 30 minutes a day), and sleep properly.

Positive thinking (seeing the glass half-full, not half-empty) is good for your health, leading to longer life, lower rates of depression and distress, greater resistance to colds, better coping skills in times of hardship and stress, and all-round better psychological and physical wellbeing. Practice positive thinking – make your self-talk positive, not negative. Smile and laugh, especially in tough times. Having a safe community of women is also very important.

You’ve probably heard this before: “you must be your own best advocate”. Many healthcare providers are not trained in menopause. Unless they work in this space they may not have the best up-to-date information on how to help women with induced menopause. Look for a healthcare provider who’s also a menopause clinician, an NCMP – menopause practitioner certified by the North American Menopause Society (NAMS). You can find an NCMP near you, or providing services online.

Teresa Isabel Dias is a pharmacist with over 25 years of professional experience in community pharmacy and drug information in Toronto. In 2013 she became a Menopause Practitioner (NCMP) certified by the North American Menopause Society (NAMS). She founded MenopausED, a virtual women’s health practice specialized in menopause. Teresa helps women navigate the change through online 101 consultations and programs. She runs the WHIM (Women’s Health In Midlife) Network a membership community of women 40-65 years old who are interested in knowing more about health in midlife, the menopause transition, and becoming their own health advocates. She also raises awareness and provides education about menopause through Lunch & Learns in the workplace.