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«Menopause and Breast Cancer About us Breast Cancer Network Australia (BCNA) is the peak national organisation for Australians affected by breast ...»

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Menopause and

Breast Cancer

About us

Breast Cancer Network Australia (BCNA) is the peak national

organisation for Australians affected by breast cancer. We provide

a range of free resources for women with breast cancer, including

the My Journey Kit for women newly diagnosed with early breast

cancer and Hope & Hurdles for women with secondary breast cancer.

BCNA’s free quarterly magazine The Beacon includes stories from

women with breast cancer, as well as information on a wide range of breast cancer issues.

Introduction 2 Menopause caused by breast cancer treatment 3 Menopausal symptoms 6

Long-term effects:

osteopenia and osteoporosis 14 More information 16 Introduction Menopause is a normal part of ageing for all women. In Australia, most women reach menopause between the ages of 45 and 55, with an average age of 51 years.

If you have reached menopause, your periods will have stopped. The ovaries stop releasing eggs each month and stop producing oestrogen. The fall in oestrogen can cause what are referred to as ‘menopausal symptoms’ – a range of symptoms and changes to your body. Symptoms may span many months or even years. The changes may be gradual, but for some women symptoms such as hot flushes can start suddenly.

Some breast cancer treatments, especially chemotherapy and hormone therapy, can cause menopause to occur earlier than it otherwise would.

For women experiencing early menopause as a result of breast cancer treatment, the symptoms may be more severe than if they had experienced a ‘natural’ menopause.

Women treated for breast cancer, either currently or in the past, may also experience menopausal symptoms for other reasons. For example, they may be experiencing natural menopause, or they may have been taking hormone replacement therapy (HRT) and stopping this medication has caused their menopausal symptoms to return.

Menopausal symptoms vary from one woman to another, both in type and severity. Common symptoms include hot flushes, night sweats, difficulty sleeping, joint pain, vaginal dryness and reduced libido (sex drive).

Menopause caused by breast cancer treatment Chemotherapy Some chemotherapy treatments can cause early menopause, which may be temporary or permanent.

A woman is born with a limited number of eggs in her ovaries. As we age the supply of eggs diminishes, leading to menopause.

Some chemotherapy drugs damage or destroy eggs, which accelerates the loss and causes menopause to occur at an earlier age than it would have

normally. Chemotherapy that can cause early menopause include:

• cyclophosphamide • doxorubicin (Adriamycin®) • paclitaxel (Taxol®, Paclitaxel®) Whether or not you are likely to experience chemotherapy-induced

menopause depends on a number of factors:

• your age – the closer you are to the usual age of menopause, the more likely menopause will be induced and will be permanent • the type of chemotherapy you are given • the cumulative dose of chemotherapy (the total amount of chemotherapy you receive over the full course of your treatment) • the number of weeks or months you are treated with chemotherapy.

In younger women (under the age of 40), menopause may be temporary.

Your periods may stop during chemotherapy treatment and you may experience menopausal symptoms. However, menopausal symptoms may improve once your periods resume after treatment.

Permanent early menopause in young women may mean coming to terms with loss of fertility. This can be very difficult to cope with if you are still considering starting a family or having more children.

Breast Cancer Network Australia (BCNA) offers a fertility decision aid for women with breast cancer who are considering their fertility options.

Details on how to order a copy are on page 17 of this booklet.

Surgery and other treatments Surgery and radiotherapy to the breast do not cause menopause. Radiation to the ovaries does cause menopause.

Some women with a genetic mutation known as BRCA1 or BRCA2 may choose to have their ovaries removed to reduce their risk of developing ovarian cancer in the future. Surgery to remove the ovaries will lead to immediate menopause.

Hormone (anti-oestrogen) therapy Many women with hormone receptor positive (ER+ and/or PR+) breast cancer will receive hormone therapy treatment after their other treatments (surgery, chemotherapy and/or radiotherapy) have been completed.

Oestrogen receptors occur naturally in the body. They are like antennas on the cells. Oestrogen circulating in the body attaches to the receptors to activate chemical changes in the cell. Normal female tissue, especially in the breast, vagina, brain, skin and bones, needs oestrogen to remain healthy.

Having oestrogen receptor positive breast cancer means that the cancer cells also have oestrogen receptors. Oestrogen circulating in the body attaches itself to the cancer cells, stimulating them so that they reproduce and grow.

If your breast cancer is hormone receptor positive (ER+ and/or PR+), you may have been prescribed anti-oestrogen medications as part of your treatment. There are two types of these medications: tamoxifen and aromatase inhibitors (Arimidex®, Femara® and Aromasin®).

Tamoxifen works by blocking the oestrogen receptors and stopping oestrogen from stimulating the cancer cells. Aromatase inhibitors work by reducing the amount of oestrogen your body makes, so that less oestrogen is circulating through your body and available to feed the cancer cells.

More information on hormone therapy is available in BCNA’s booklet Hormone therapy and breast cancer. Information on how to order a copy can be found on page 17 of this booklet.

Menopausal symptoms The symptoms of menopause vary from one woman to another, both in type and severity. They may also mimic some of the side effects of cancer and its treatments.

Common symptoms include:

• vasomotor symptoms such as hot flushes, night sweats, palpitations and shortness of breath • urogenital symptoms such as vaginal dryness, painful intercourse, loss of libido (sex drive) and urinary symptoms • cognitive and emotional symptoms such as anxiety, depression, difficulty concentrating and poor memory • other symptoms such as insomnia, lack of energy, aches and pains, and breast tenderness.

Hot flushes The hot flushes were a challenge for a while, but by layering my clothes and using a hand-held fan I was able to manage them quite effectively.

Thankfully, I now only experience them very occasionally. – Kym Hot flushes are the most commonly reported menopausal symptom associated with breast cancer treatment. Up to 80 per cent of women with breast cancer, particularly younger women, experience hot flushes. Hot flushes may be more severe and frequent than in women without breast cancer and may persist for many years following breast cancer treatment.

How often you experience hot flushes can vary – from a couple per day to several every hour. They can range from a mild sensation of warming which just affects the face to waves of heat through the whole body. They may be accompanied by drenching perspiration, palpitations (feeling the heart is racing), anxiety or nausea. Flushes may be worse at night and accompanied by drenching sweats and disturbed sleep. Hot flushes can also affect your mood, and can leave you feeling irritable and tired.

If you are experiencing hot flushes, there are things you can try that may

help. Some suggestions include:

• Minimise stress where possible. Feeling overwhelmed and anxious may trigger hot flushes. Stopping every so often to take a deep breath may help you relax.

• Meditation, yoga and other relaxation techniques have been shown to be beneficial.

• Aim to maintain your ideal weight.

• Aim to exercise for 30 minutes most days.

• Stop smoking.

• Wear loose cotton clothing to allow your skin to breathe. Wearing clothing in layers can also help, as you can take layers off during a hot flush.

• Avoid anything that triggers your hot flushes, such as hot spicy food, alcohol and caffeine.

• Drink cold water to help to lower your body temperature.

• Avoid hot environmental temperatures and stuffy rooms.

• Use water sprays or moist wipes to help lower your skin temperature.

• Use an electric or handheld fan to lower your skin temperature.

• Use cotton bed sheets instead of synthetic sheets to help breathability.

• Take a cool shower before bed.

• Use cold packs including a cool gel pack under your pillow at night.

Prescription medicines If the strategies outlined above don’t help and you are finding hot flushes troublesome, you may like to talk to your GP or medical oncologist as there are a number of medications that can be used to treat hot flushes.

These include a low-dose antidepressant such as venlafaxine (Efexor®), or other drugs including clonidine (Catapress®) and gabapentin (Neurontin®, Pendine®). Clonidine is generally used to treat high blood pressure, but can be used to reduce menopause-related hot flushes after breast cancer. Gabapentin is used to treat chronic pain. It can also be effective in reducing hot flushes. Let your doctor know if you are taking tamoxifen because some antidepressants, especially paroxetine (Aropax®), reduce its effectiveness.

None of these medications is listed on the Pharmaceutical Benefits Scheme (PBS) for hot flushes, however, they are on the PBS for other conditions.

If they are prescribed for you as a non-PBS drug, it may be worth checking the cost of the prescription at different pharmacies to obtain the best price.

If you have private health insurance, your fund may provide you with a rebate so it’s worth checking with them.

Hormone replacement therapy (HRT) replaces hormones (oestrogen and/ or progesterone) that are no longer being produced by the ovaries and is very effective in reducing menopausal symptoms. HRT can also protect against long-term side effects of menopause, especially osteoporosis.

However, HRT is not usually offered to women who have had oestrogen receptor positive (ER+) breast cancer, as there is uncertainty as to whether it may increase the risk of the breast cancer coming back. Your medical oncologist will be able to advise you on the appropriateness of HRT if your symptoms are severe and impacting on your quality of life.

Complementary medicines There are a number of complementary medicines, health supplements and foods that are promoted as useful in managing hot flushes. Many of them have not been proven to be effective in clinical trials, and some may interfere with your breast cancer treatments.

It is important to talk to your doctor about any complementary medicines or herbal therapies you are considering or currently taking, particularly if you are taking hormone treatment such as tamoxifen or an aromatase inhibitor (Arimidex®, Femara®, Aromasin®).

Bio-identical hormones are lozenges, troches or creams prepared by compounding pharmacists designed to be absorbed through the cheek or skin. They are individually prepared rather than manufactured by a pharmaceutical company, hence quality controls may be inconsistent and they are not subject to approval by the Therapeutic Goods Administration.

The manufacturers claim the products are natural oestrogen, but they come from the same sources as traditional HRT. There has been no formal research into their dosage, effectiveness in reducing hot flushes, or their safety.

Phytoestrogens (plant oestrogens) are chemicals found in plants that mimic the effect of oestrogen on the body. High quantities are found in soybeans and linseed. You can buy phytoestrogen-rich foods and supplements from health food shops. As they are classified as foodstuffs they are not covered by drug regulations or clinical trials. Their safety after breast cancer is not known and their effectiveness in reducing hot flushes has not been proven.

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