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?