Menopause and Breast Cancer

Professor Christobel Saunders talks about managing menopause symptoms after breast cancer.

Hello, I’m Chistobel Saunders, Professor of Surgery at the University of Western Australia and a breast cancer surgeon at St. Charles Gardiner and Royal Perth Hospitals. I joined the Editorial Advisory Board at the Virtual Cancer Centre a few years ago and today I’d like to share with you my insights on how to manage menopause symptoms in women after breast cancer.

The great majority of breast cancer patients of all ages report menopause symptoms, particularly hot flushes, which may be severe. These can be due to stopping HRT when breast cancer is diagnosed or due to the breast cancer treatments such as endocrine therapies, chemotherapy, and stopping the ovaries functioning. Premature menopause or menopausal symptoms in breast cancer patients have a significant impact on women’s quality of life, body image, sexual function and self-esteem. Hence, it’s not surprising that menopausal symptoms are one of the most common troublesome side effects of breast cancer therapy in women of all ages. In fact, up to 20% of breast cancer patients consider stopping their endocrine therapy because of these symptoms despite knowing that this treatment will reduce their chance of recurrence.

HRT is, of course, the most effective treatment for menopausal symptoms in healthy women but we do not know how well it works in those who have had breast cancer and, more importantly, studies suggest it may increase the risk of both new breast cancers and recurrence of a previous breast cancer. Many women therefore wish to avoid HRT following breast cancer and some indeed believe that the HRT may have contributed to their disease.

Progestins are drugs which may be unsafe following breast cancer and therefore we usually don’t use. A synthetic HRT called tibolone is effective in reducing hot flashes. However, a recent trial after breast cancer has been halted following an increase in breast cancer recurrence.

Women can help themselves with simple lifestyle changes: hot flushes may be triggered by spicy foods, heat raises or anxiety, by being overweight and smoking. Physical activity can help many women manage their symptoms. Over the counter preparations such as phytoestrogens or black cohosh have unfortunately not consistently been shown to be effective for menopausal symptoms and their safety after breast cancer is unknown.

However for mild symptoms high dose vitamin E can be useful in some women. Of prescribed drugs there are agents such as gabapentin, clonidine, and even the antidepressants SSRIs, which appear to be effective. However, it is only the drug gabapentin that has been shown to work for over a period of 6 weeks, and side effects on all of these drugs are common.

Vaginal dryness is a common symptom, which can be managed with simple lubricants such as replens or with estrogen creams. Bone loss is also a common side effect of menopause. Women need to consider lifestyle factors such as increasing calcium intake, exercise and avoidance of smoking and excess alcohol, to try to prevent this.

Finally, it’s important that the management of menopausal symptoms following breast cancer needs a specialist approach, with expertise from a number of different health professionals. Women should discuss their symptoms with their GP and with their breast cancer doctor.

Thank you for your interest.

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