The following article features in Issue One of the ST BREAST magazine.
Menopause can be difficult when a woman is well, but when it’s part of breast cancer treatment, symptoms like hot flushes and vaginal dryness can be particularly debilitating. But Associate Professor John Eden from Sydney’s Prince of Wales Hospital, says women should know that there is much that can be done to manage menopause both during and after breast cancer therapy. Not that he is downplaying the distress these symptoms cause some of his patients.
“The big problems are severe flushing and severe vaginal dryness. These can be terrible problems for women, and I have women who come to me crying they are so distressed – just the lack of sleep from the hot flushes can be awful.
“It can be 5-10 flushes per hour day and night, waking every 30 minutes. People don’t really realise how bad it can be. For these women who have had treatment for breast cancer and are put into menopause very suddenly, it can be very debilitating.”
Associate Professor Eden says menopause may be the result of commonly-used chemotherapy agents, which can damage eggs and deplete what is a finite egg reserve.
“The younger you are, the less likely you are to go through menopause,” he says. “It is much more common in older women. We typically see it by the second month of treatment. They get severe sweats and flushes because of the suddenness of it. We see the same problem with someone who has had surgery and had their ovaries removed.”
Associate Professor Eden says chemotherapy-induced menopause is usually permanent, however there are exceptions.
“Some young women have their ovaries stunned and then their cycle returns, but for the vast majority, it is permanent. If you go into menopause and you are over 40, it is likely to be permanent. Even those women who do get their ovarian function back will go into menopause a lot earlier than anyone else.”
Associate Professor Eden says women whose cancers are hormone-sensitive may also be prescribed drugs to block ovarian function. “This is often combined with another endocrine therapy and again, the body will be put into menopause. In these cases, the menopause is reversible, although women will still have menopausal symptoms while ovarian function is blocked.”
Associate Professor Eden says the good news is that there are a number of therapies available to manage hot flushes.
He says lifestyle strategies can be largely ineffective, so his first option is a complementary therapy known as Remifemin Plus, which includes an extract of black cohosh and St John’s Wort. “This has been shown in numerous clinical trials to be equivalent to low-dose hormone therapy, which is pretty impressive for the relief of hot flushes.
“It has also been shown in the laboratory to inhibit oestrogenreceptor- positive and breast cancer cells. Just about every other herbal extract women try for menopause contains plant oestrogens and certainly women with breast cancer should stay away from those.”
Associate Professor Eden says there are a number of other treatment options to help manage hot flushes.
Another common menopause symptom that breast cancer patients frequently need help with is vaginal dryness.
“It can be so severe they can’t have intercourse at all, and even walking is uncomfortable,” Associate Professor Eden says.
“We are using a lot more aromatase inhibitors these days and they seem to completely oestrogen-deplete a woman, so the vaginal dryness problem is particularly common now and particularly severe.”
He said there are a number of treatments that will provide relief, but the first thing he advises is to “get rid of soap”.
“Australian women don’t want to use soap on their face because they are worried about drying their skin out, but they seem to think it’s fine to wash their bottom and vulva with soap. They should stop this and use a gentle wash, like Cetaphil or QV – things that are often used for eczema.
“They can also try a vaginal moisturising product or use basic coconut oil or olive oil lubricants. There is also a good natural product called Sylk. A lot of these remedies make everything much better, although you are left with a small group – about 1 in 5 – who have a major problem.”
Associate Professor Eden says those who continue to suffer may want to try CO2 laser therapy to regenerate vaginal walls.
“Basically, it has been used in dermatology for decades and it thickens vaginal and vulval skin. It helps an awful lot of patients. For the 1% who say nothing works, we do sometimes use low-dose hormone treatment.
“The real message here, is that there is a lot we can do and people don’t have to live with these symptoms. A lot of women just don’t realise it’s fixable.”
Associate Professor John Eden
Associate Professor John Eden is a gynaecologist and reproductive endocrinologist (a specialist in women’s hormones). He has had a 30-year research interest in how women can maintain quality of life after breast cancer and is currently part of the multi-disciplinary breast cancer group at the Prince of Wales Hospital in Sydney.
Please consult your oncologist before taking any complementary medicine as these may interact with your current medication/s.