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«Breast cancer and early menopause a guide for younger women Breast cancer and early menopause a guide for younger women Breast cancer and early ...»

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What helps?

Although we don’t know how to stop hot flushes, there are some things you

can do to help manage the symptoms:

wear natural fibres like cotton which absorb sweat dress in layers, so that it’s easy to take off an item of clothing when you experience a hot flush reduce your intake of caffeine, alcohol, hot drinks and spicy foods keep a small fan in your work area and drink cold water to cool you down keep a note of when you experience hot flushes and what you’re doing when they occur; this may help you identify the ‘triggers’ that cause your flushes and help you find ways to avoid them consider meditation consider other lifestyle strategies, such as a healthy diet, regular exercise and not smoking.

Staying cool in bed:

keep cold water by your bed ready to drink at the first sign of a sweat use cotton sheets and cotton nightclothes sleep under layers, so you can easily remove extra bed covers have a small fan running to keep the air moving while you sleep.

Some women have found they can relieve the symptoms if they switch to deep, slow abdominal breathing (controlled breathing) at the first sign of a hot flush.

–  –  –

If you think you would find it helpful to share your experiences with other women, you may like to join a support group. Meetings can be face-to-face or held over the telephone or internet.

–  –  –

Sexuality and libido Menopause can cause a loss of libido, and can decrease your desire for sexual intimacy.

Managing these symptoms may require some effort – and open communication between you and your partner.

Menopause can reduce the body’s production of the hormone oestrogen.

Oestrogen is important for maintaining the moisture and elasticity (stretch) of the vagina. When oestrogen levels are lower, vaginal dryness and loss of vaginal elasticity can make sexual intercourse uncomfortable or painful.

Unlike hot flushes, vaginal dryness does not improve with time and may be a long-term problem unless treated.

Some women say it takes longer to become aroused and experience orgasm during and after menopause. The loss of desire and libido may be directly related to lower levels of the hormones oestrogen, progesterone, or testosterone. Vaginal dryness and pain may further increase the problem.

Changes in libido may not only be the result of your menopausal symptoms.

Breast cancer and its treatment can influence your overall sense of femininity and sexuality. This can happen to any woman, whether or not she has a partner.

20 – Breast cancer and early menopause — a guide for younger women What helps?

There are a range of practical and lifestyle remedies that can help manage some of the effects of early menopause on sexuality and libido, including managing vaginal dryness.

Be open with your partner; explain what is happening and what might be helpful for you.

Relaxation techniques may help to reduce your stress levels and help you refocus on your relationship.

Treat vaginal dryness if it is causing discomfort (see next section for details).

Downplay the importance of sexual intercourse and orgasm, at least for a while. Instead, focus on the pleasure of touching, kissing, and imagery.

Women need foreplay to become properly aroused, so don’t hurry this aspect of your relationship, and let your partner know what helps.

You and your partner may find it helpful to talk to a health professional – you can do this together or separately. You may want to ask for advice from a trained specialist such as a relationship counsellor or sex therapist.

What to do about vaginal dryness The most effective solution for vaginal dryness is to use a product that will add moisture to the vaginal tissue. There are three types of vaginal moisturisers. All are applied directly into the vagina.

Non-hormonal vaginal moisturisers Non-hormonal vaginal moisturisers provide relief from the uncomfortable symptoms of vaginal dryness. These products (eg Replens®) come in a semiliquid form and are usually applied twice a week. They are available from most pharmacies.

Vaginal lubricants Vaginal lubricants provide lubrication to enhance the comfort and ease of sexual intercourse. These products (Sylk®, Astraglide® or KY®Jelly) come as ‘semi-gel’ creams. They are available from pharmacies.

–  –  –

Vaginal oestrogens are creams containing low doses of the hormone oestrogen. They are designed to help retain vaginal elasticity and to replace moisture. They are used about twice a week. Vaginal oestrogens must be prescribed by a doctor.

When vaginal oestrogens are used, minimal amounts of oestrogen may be absorbed into the body. We don’t yet know whether vaginal oestrogens are safe for women who have had breast cancer. Because of this, vaginal oestrogens should only be prescribed by a medical practitioner who is aware of your history of breast cancer. It is important to check with your oncologist before using a vaginal oestrogen.

Other ways of managing vaginal dryness Avoid substances that can irritate or dry the vaginal region, such as soap, or products containing alcohol or perfume. Products containing petroleum jelly and baby oil can also cause irritation. Use a soap-free product to wash the vaginal area.

Wear cotton underwear and avoid nylon underwear, tight underwear, or tight clothing.

If you’re sexually active, discuss your concerns with your partner. If your partner is aware of how you feel, he or she is more likely to help you explore alternatives.

Simple strategies, such as changing the position for intercourse, can relieve discomfort. Pain during sex can make you tense, and that tension can cause more pain. Try exploring alternative ways to be intimate so you and your partner can maintain a pleasurable and satisfying sexual relationship.

22 – Breast cancer and early menopause — a guide for younger women Insomnia and disrupted sleep Many women experience disturbed sleep during menopause.

You may wake up sweating from a hot flush. Getting to sleep can also be difficult. Disrupted sleep can cause fatigue and tiredness. If you experience sleeping difficulties, try relaxation or meditation techniques.

If you’re regularly waking up feeling anxious and worried, talk to a member of your health care team. Treatments are available that can help.

What can help?

There are a number of things that may help you sleep better.

Before bed, avoid caffeine-based drinks, alcohol, and other stimulants like cigarettes and TV. If you’re used to having a bedtime drink, try a nonstimulating herbal tea, like chamomile.

Use the bedroom for sleep only – no TV or written work (sex is fine!).

Establish a regular bedtime and waking routine – its OK to take short naps (no longer than an hour) during the day, but try not to rest for long periods.

Keep your bedroom cool.

Gently increase your physical activity during the day – such as walking or swimming.

Try controlled breathing – deep slow abdominal breathing.

Try relaxation or meditation techniques.

Consider asking your general practitioner for a short-term mild sedative.

Bladder problems Bladder problems – such as incontinence, passing urine more frequently at night and urinary tract infections – can become more frequent during menopause.

If you experience a burning pain when passing urine, or if you feel the need to go to the toilet frequently yet pass only small amounts of urine, see your general practitioner. You may have a bladder infection that requires treatment with antibiotics.

–  –  –

What can help avoid incontinence?

Try pelvic floor exercises to reduce urine leakage and improve bladder control. Exercise brochures are available from most general practitioners and chemists. You may find it helpful to seek advice from a physiotherapist ask your general practitioner or breast care nurse for a referral.

Avoid food and drinks containing high levels of caffeine as this can irritate the bladder and can increase incontinence.

Visit your local continence advisory service. Ask your general practitioner or breast care nurse for more information.

Fatigue and tiredness Feeling fatigued or constantly tired is a common symptom of menopause and is a side effect of treatments for breast cancer.

During menopause, disrupted or reduced sleep is the major cause of fatigue and tiredness. Regardless of what is causing your tiredness, exercise can help reduce the symptoms.

–  –  –

Establish a gentle regular exercise program, varying the exercise so you don’t get bored.

If you haven’t exercised for a while or have other medical conditions, ask your general practitioner about the type and amount of exercise you should undertake.

Increase your level of activity gradually.

24 – Breast cancer and early menopause — a guide for younger women Ask a friend to exercise with you to help keep you motivated.

If you’re experiencing significant fatigue, take on a small activity, followed by a rest period, followed by another activity.

Avoid long periods resting in bed; it will only increase your fatigue.

Eat a diet that includes at least 2 serves of fruit and 5 serves of vegetables a day.

Drink enough water (about 8 glasses a day is recommended) so that you do not feel thirsty. Dehydration can also be the cause of fatigue.

Effects on memory Menopause does not cause you to lose your memory.

However, changes in sleep pattern, tiredness, and anxiety can cause you to become forgetful and may impair your mental functioning.

What can help?

Make lists of things that are important to remember.

Stay mentally active—try a crossword, Sudoku or quizzes.

Keep a brief diary of appointments and things to do and check it regularly.

Regular exercise can help improve your sleep patterns.

Explain to everyone what is happening to you so they can help and give you support.

Bone and joint pain Painful joints can be a problem associated with menopause and can also be a side effect of drugs used to treat breast cancer, such as aromatase inhibitors used for postmenopausal women. Sometimes joints can feel stiff and sore.

What can help?

Exercise can help to maintain a range of movement and maintain a healthy weight. You may wish to talk to a dietician and ask about vitamin supplements.

If you have bone or joint pain, tell your general practitioner to check that you don’t have other joint changes, such as arthritis.

–  –  –

Maintaining a healthy weight is an important aspect of a long-term health for cancer survivors. There are many ways to avoid weight gain and to lose additional weight if you put it on. Talk to your general practitioner, breast care nurse or ask to speak to a dietician for advice.

–  –  –

Eat a healthy diet, including lots of fresh fruit and vegetables.

Reduce your intake of fats, especially saturated fats.

Drink more water and less sugary liquids like soft drink and fruit juice.

Participate in regular physical activity.

Drink no more than one or two standard alcoholic drinks a day (a ‘standard drink’ is one small glass of wine).

You can get detailed advice on your particular needs from an accredited, practising dietician.

–  –  –

Self care Some women find it helpful to take ‘time out’. This can mean enjoying a long bath, a massage, weekends away with loved ones, or a long walk in a favourite environment. Taking care of yourself is not being selfish. The relaxation it brings can help reduce stress levels and help you cope.

–  –  –

Listed below are some questions you might want to ask about how to manage menopausal symptoms.

Can you refer me to a menopause specialist to discuss my symptoms?

–  –  –

26 – Breast cancer and early menopause — a guide for younger women Can I speak to a dietitian?

What level and types of exercise are suitable for me?

How will menopause affect my sex life?

What products can I use to help manage vaginal dryness?

Can my partner speak to a sexual therapist/counsellor?

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