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Understanding Immunology

Symptoms & Treatment

A woman can arrive at menopause in one of three ways: naturally, simply by living long enough; surgically, by having her ovaries removed; and chemically, through breast cancer treatments. Women who have had breast cancer may experience the same menopausal symptoms as any other woman. The difference is the options for dealing with these symptoms are dictated in part by a woman's history of breast cancer.

Breast cancer interacts with menopause in unique ways. A woman who has a mastectomy but not chemotherapy or hormone therapy may experience menopause naturally. Or she could be thrown into menopause by a hysterectomy that includes removal of the ovaries (oophorectomy) for a problem unrelated to her cancer. Some premenopausal women become menopausal as a result of their chemotherapy treatments. In other instances, a premenopausal woman's treatment may include a drug such as goserelin (brand name Zoladex) that puts her into temporary menopause by suppressing ovarian functioning and decreasing estrogen levels. The final situation is when a woman abruptly stops taking hormone replacement therapy that she had been taking before her diagnosis. This sudden change in hormone levels will often lead to worse symptoms.

Women who have not had breast cancer can consider short-term use of menopausal hormones to help alleviate menopausal symptoms. But, a 2004 study showed and a 2015 study confirmed, menopausal hormone therapy is not an option for women who have had breast cancer. Many studies show a link between higher breast cancer risk and using HRT to treat menopausal symptoms. The results of all the studies aren’t exactly the same but they come to similar conclusions including:

  • HRT increases invasive breast cancer risk.
  • Breast cancer risk goes up during the first several years of using HRT; risk seems to keep increasing the longer a woman uses HRT.
  • High-dose HRT increases risk more than low-dose HRT.
  • Combination HRT increases risk more than estrogen-only HRT.

Additionally, bioidentical or "natural" hormones are not an option either. That's because it is likely that the problems associated with menopausal hormones are not due to the type of hormones a woman is taking but the fact that she is taking hormones in the first place.

Menopause affects different women in different ways. You only have to "treat" or "manage" menopause if it is interfering with your life. But if you have had breast cancer and you can't use menopausal hormones, what can you do?

Hot flashes have become known as the hallmark of menopause, although they are far from universal. Only about 50% of postmenopausal women have hot flashes, and only about 15% have severe ones. Most women have hot flashes for about two years; few have them for more than six years.

In July 2002, everything many doctors thought they knew about menopausal hormone therapy (called hormone replacement therapy (HRT) at the time) was called into question when researchers announced that they were stopping the Women's Health Initiative (WHI), a large randomized placebo-controlled study designed to measure the benefits and risks of menopausal hormone therapy. The study was stopped because an interim data analysis indicated that the risks of this therapy outweighed any benefits the drugs had to offer.

Not all women want to take hormone replacement therapy (HRT), and women who have had breast cancer or are at high risk for breast cancer are not advised to do so, due to fears it will increase the risk of cancer or a recurrence. What options are available to these women?

Prescription options for treating hot flashes include antidepressants, gabapentin, and clonidine.

Not all women want to take hormone replacement therapy (HRT), and women who have had breast cancer or are at high risk for breast cancer are not advised to do so, due to fears it will increase the risk of cancer or a recurrence.

The other option is to try to avoid hot flash triggers like spicy foods, caffeine, stressful situations, and hot drinks. You may also want to try sleeping in a cool room; carrying a hand fan; dressing in cotton and in layers; or paced respiration exercises (deep, slow abdominal breathing).

Not all women want to take hormone replacement therapy (HRT), and women who have had breast cancer or are at high risk for breast cancer are not advised to do so, due to fears it will increase the risk of cancer or a recurrence.

Vaginal dryness is perhaps the most distressing and least talked about symptom of menopause. Vaginal dryness probably results from changes that occur when estrogen levels drop. Low estrogen causes the vagina and surrounding connective tissue to lose elasticity and the tissue that lines the vagina becomes thinner and more fragile. Vaginal dryness occurs in about 20% of women, sometimes transiently and other times permanently. If you're sore from vaginal dryness, you don't want to have sex and if you don't have sex, your vaginal dryness gets worse—a classic catch-22.

Although insomnia is often related to night sweats, it is also true that you don't sleep as well when your hormones are awry.

Some easy measures can help. These include:

Menopause—whether it occurs naturally, due to chemotherapy, or due to removal of the ovaries—often causes vaginal dryness, hot flashes, and irritability. These emotional and bodily changes can undoubtedly affect one's sexuality. So can relationship problems, job stress, depression, antidepressants (one side effect of many is low libido), and other factors.

The following are sometimes recommended to increase libido:

Mood swings typically affect not only you, but also those around you. If you are trying to handle mood swings, a lifestyle approach is a good place to start. Some recommended lifestyle changes include:

The condition called "fuzzy thinking" is probably the most disturbing symptom of perimenopause. Fuzzy thinking has elements of memory lapse and attention deficit disorder. You may run into a longtime acquaintance and realize that you can't remember her name. You may go upstairs to get something and, by the time you get there, forget what it is. It may be difficult to concentrate, and you may get easily distracted. It's known to be transient, but it can be a real impediment to our efficiency.

Incontinence, or leaking urine, is a common problem related to aging. There are two types of incontinence, stress incontinence and urge incontinence, and both are more common after menopause.

​I am postmenopausal and have hormone-sensitive early breast cancer. I have been taking tamoxifen for two years. Should I switch to an aromatase inhibitor?

When the first aromatase inhibitor anastrozole (brand name Arimidex) was approved for use in the adjuvant setting in 2002, one of the initial questions discussed was: Should women stop taking tamoxifen and switch to Arimidex?