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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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Herbal therapies such as ginseng, passionflower, valerian, chaste tree, St John’s Wort, black cohosh and gingko are also used by some women to manage hot flushes. They are also classed as foodstuffs and not subject to thorough clinical trials. Opinion is divided as to whether they are safe to use after breast cancer. Some, such as St John’s Wort, can reduce the effectiveness of tamoxifen and chemotherapy drugs, so should not be used while you are undergoing breast cancer treatment.

Complementary therapies In recent clinical trials, cognitive behaviour therapy has been shown to reduce the impact of hot flushes, to reduce anxiety and improve sleep after breast cancer. Other therapies which may help include yoga, hypnosis, relaxation therapy, paced respiration, acupuncture and mindfulness meditation.

Alternative therapies There is currently a lack of evidence for homeopathy, reflexology or body manipulation improving hot flushes.

Vaginal symptoms My libido and lubrication has diminished, but my love for my husband hasn’t. If intercourse is uncomfortable we find other ways to enjoy sensuality and intimacy with each other. – Mary Menopause may cause loss of libido and vaginal symptoms such as vaginal dryness and painful intercourse.

There are a number of products you can try to help manage vaginal dryness.

Some women find that a non-hormonal vaginal moisturiser such as Replens® (a low pH gel), available from pharmacies, provides relief from vaginal dryness, itching and irritation.

When applied directly to the vagina, vaginal moisturisers help replenish moisture to the lining of the vagina and relieve discomfort associated with vaginal dryness. Vaginal moisturisers are designed to be applied twice a week, but can be used more or less frequently as necessary.

It’s important to be aware that while vaginal moisturisers can improve vaginal symptoms and sexual function, depending on the severity of vaginal dryness they are likely to take around six to eight weeks to be fully effective.

Vaginal oestrogens are the most effective treatment for vaginal dryness.

However, doctors are cautious about prescribing vaginal oestrogens to women who have had breast cancer, particularly those women who have had oestrogen receptor positive breast cancer. These creams or vaginal tablets contain low doses of oestrogen, which may be absorbed into the body at low levels. You may like to discuss with your specialist whether a vaginal oestrogen is suitable for you. Vaginal oestrogens are only available on prescription by a doctor.

If you are experiencing vaginal symptoms, you may find that sex is painful.

Vaginal lubricants can be used in sexual foreplay immediately before and during sex to provide lubrication, and to reduce pain and discomfort from dryness.

Avoid using petroleum or oil-based lubricants as they can interfere with the vagina’s natural secretions and can worsen vaginal dryness. If you are prone to vaginal thrush, use water-based lubricants as lubricants with high levels of glycerine or silicone may cause recurring vaginal thrush.

BCNA has a booklet available for women called Breast cancer and sexual wellbeing, which includes more detailed information about vaginal symptoms and sexual wellbeing issues. Details on how to order a copy are on page 17 of this booklet.

Mood changes When you go through menopause the fall in oestrogen can also affect your brain, resulting in poor concentration, forgetfulness and mood swings. You may find that your moods change from day to day – you may be irritable some days, positive and happy on others, and miserable and sad on yet others. Fluctuating moods are a common menopausal symptom.

Relaxation classes, tai chi, yoga and meditation can all assist with mood changes and concentration. Regular exercise may also help. Many women find that joining a support group and sharing their feelings also helps them to understand and manage their mood swings.

If your moods are persistently low and you find you are losing interest in activities you normally enjoy, or you have less energy or difficulty sleeping, or if anxiety is a persistent feeling, it is important that you discuss your symptoms with your doctor or breast care nurse to exclude underlying depression.

Joint pain The symptoms do settle down after a while. The worst for me is the joint aches. But even those have settled down a bit with time. – Christine Joint pain and/or stiffness are common menopausal symptoms and may be worsened if you are taking aromatase inhibitors such as Arimidex®, Femara® or Aromasin®.

Strategies that may assist you to manage joint pain include:

• gentle, low-impact exercise including hydrotherapy (exercising in a heated pool) • yoga or tai chi • acupuncture • over-the-counter mild analgesics such as paracetamol or ibuprofen (if you are undergoing chemotherapy seek the advice of your oncologist before taking ibuprofen or other anti-inflammatory medications) • fish oil supplements • maintaining a healthy weight to reduce stress on the joints.

If you are taking an aromatase inhibitor and the joint symptoms are severe and distressing, discuss this with you doctor. S/he may be able to change the hormone therapy you have been prescribed to a different aromatase inhibitor or to tamoxifen, which is associated with fewer joint symptoms.

Long-term effects: osteopenia and osteoporosis I knew that osteoporosis was a risk factor when I made the decision to take an aromatase inhibitor. I do what I can to minimise the risk, such as walking, watching my weight, eating calcium rich foods and having regular checks for my vitamin D levels. It was the right decision for me. – Sally After menopause, a woman’s bone density falls between one per cent and three per cent every year. If your bone density drops too much, there is a risk you may develop osteopenia or osteoporosis, leading to an increased risk of fracture.

Osteopenia (lower than normal bone mineral density but not low enough to be defined as osteoporosis) and osteoporosis can be diagnosed with a bone mineral density scan called a DXA scan. This is different from the bone scan you may have to determine if breast cancer has spread to other parts of your body.

Women who are at increased risk of osteopenia and osteoporosis are

those who:

• have experienced early menopause, i.e. before the age of 45 • have a family history of osteoporosis • are very thin • are of Asian descent • smoke.

In addition to the normal fall in bone mineral density caused by menopause, some breast cancer treatments, in particular aromatase inhibitors, can reduce bone mineral density. Your doctor will monitor your bone mineral density if you are taking one of these medications.

There are things you can do to reduce your risk of developing osteoporosis.

These include:

• 30 minutes of weight-bearing exercise most days. Weight-bearing exercise includes walking, running or dancing rather than non-weightbearing exercise such as swimming or cycling • ensuring an adequate intake of vitamin D and calcium. Your doctor may recommend a blood test to check your vitamin D levels and may suggest supplements if they are low.

Medications such as bisphosphonates may be prescribed if you develop osteoporosis and are at increased risk of fracture.

More information Menopause clinics There are a number of menopause clinics around the country that can provide counselling and advice on managing menopausal systems. A referral from your GP or specialist may be required.

ACT Menopause Centre Canberra Level 1, 28 University Ave, Canberra (02) 6248 6222 New South Wales Menopause Unit The Royal North Shore Hospital, 209 Pacific Highway, St Leonards (02) 9926 7686 Sydney Menopause Centre Royal Hospital for Women, Barker St, Randwick (02) 9382 6620 South Australia Menopause Clinic Women’s Health Centre, Royal Adelaide Hospital, North Tce, Adelaide (08) 8222 5587 Menopause Clinic Women’s and Children’s Hospital, 72 King William Rd, North Adelaide (08) 8161 7592 Victoria Southern Health Menopause Clinic Monash Medical Centre, 246 Clayton Rd, Clayton (03) 9594 6666 Menopause Symptoms After Cancer Clinic The Women’s Hospital, cnr Grattan St and Flemington Rd, Parkville (03) 8345 2191 Jean Hailes Medical Centre for Women 173 Carinish Road, Clayton (03) 9562 7555 Western Australia Menopause Symptoms after Cancer Clinic King Edward Memorial Hospital, Bagot Road, Subiaco (08) 9340 1355 Breast Cancer Network Australia www.bcna.org.au

Breast Cancer Network Australia produces a range of resources including:

• Breast cancer and sexual wellbeing, a booklet for women and their partners. This booklet provides information and advice about the practical and emotional aspects of breast cancer and sexual wellbeing issues.

• Hormone therapy and breast cancer, a booklet for women who are being treated with hormone therapies for oestrogen receptor positive (ER+) breast cancer.

• Breast cancer and exercise, a booklet for women with breast cancer about exercising for good health.

• Fertility-related choices: a decision aid for younger women with early breast cancer, a booklet for young women who have recently been diagnosed with early breast cancer.

• BCNA’s online network allows you to connect and share stories with women in a similar situation. To join, visit www.bcna.org.au Cancer Australia (formerly National Breast and Ovarian Cancer Centre) www.canceraustralia.gov.au Cancer Australia is the Australian Government’s national cancer agency.

It provides leadership in cancer control to improve outcomes for Australians affected by cancer. Cancer Australia develops and distributes clinical guidelines for best practice health care to improve the diagnosis, treatment and support of women with breast cancer. It produces a number of information resources for health professionals and people

affected by breast cancer, including:

• Breast cancer and early menopause: a guide for younger women, a booklet for younger women diagnosed and treated for breast cancer who may be at risk of early menopause Jean Hailes for Women’s Health www.jeanhailes.org.au Jean Hailes for Women’s Health is a not-for-profit organisation dedicated to the physical and emotional wellbeing of women across Australia. It translates the latest research findings into practical health and lifestyle approaches for women and professional advice for nurses, GPs and health specialists. Jean Hailes produces fact sheets and written advice on its website about menopause, bone health, sleep, vitamin D, nutrition for women and more.

Cancer Council Helpline Cancer Council Helpline is a free, confidential telephone information and support service run by Cancer Councils in each state and territory.

Specially trained staff are available to answer questions about cancer and offer emotional or practical support.

Other useful websites Australasian Menopause Society www.menopause.org.au/consumers Bone Health for Life www.bonehealthforlife.org.au Early Menopause www.earlymenopause.org.au Managing Menopause www.managingmenopause.org.au North American Menopause Society www.menopause.org/expertadvice.aspx Osteoporosis Australia www.osteoporosis.org.au US Endocrine Society www.hormone.org/Menopause/ Breast Cancer Network Australia 293 Camberwell Rd Camberwell VIC 3124 www.bcna.org.au

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