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 that 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 hormone replacement therapy (HRT) to help alleviate menopausal symptoms. But a 2004 study confirmed that HRT is not an option for women who have had breast cancer. Bioidentical or "natural" hormones are not an option either. That's because it is likely that the problems associated with HRT are not due to the type of hormones a woman is taking but the fact that she is taking "replacement" 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 HRT, what can you do?
Options for Women with Breast Cancer
Treating Hot Flashes
Options for treating hot flashes include avoiding hot flash triggers, like spicy foods, caffeine, stressful situations, and hot drinks. You may also want to try sleeping in a cool room; carrying a hand fan; dressing in cotton and in layers; paced respiration exercises (deep, slow abdominal breathing); acupuncture; eating a serving of soy foods and ground flaxseeds daily; or walking, swimming, dancing, or bike riding every day for 30 minutes or more. You can also try vitamin E (800mg) or the herb black cohosh. If nothing helps alleviate your symptoms, you may want to join or create a support group to help you deal with them.
Treating Vaginal Dryness
Vaginal dryness is perhaps the most distressing and least talked about symptom of menopause. It occurs in about 20 percent of women, sometimes transiently and other times permanently. Sexual activity, including masturbation, reduces vaginal atrophy. The problem is that if you're sore from vaginal dryness, you don't want to have sex, and if you don't have sex, your vaginal dryness gets worse—a classic catch-22.
Water-based lubricants, like KY Jelly and Astroglide, can't cure the condition, but they can help with painful intercourse. To treat the condition, you need a product that can increase the vagina's own moisture, like Replens, which can be purchased over the counter. If that doesn't work, you may want to have your doctor prescribe estrogen, in the form of Vagifem or the Estring. Estrogen cream, such as Estrace, is not recommended. Neither is the Femring, which is a form of HRT.
Treating Insomnia, Mood Swings, and Fuzzy Thinking
Although insomnia is often related to night sweats, it is also true that you don't sleep as well when your hormones are awry. Some easy measures can help. For example, keep your bedroom cool, exercise (but earlier in the day, as exercising right before going to bed will keep you awake), avoid caffeine and liquor, and take warm baths or showers. To counter mood swings and anxiety, try exercise (yoga is especially good), meditation, eating a plant-based rather than a meat-based diet, going to a psychotherapist, or finding creative outlets.
An inability to concentrate or remember things has been attributed to changes in hormones. Fuzzy thinking is not uncommon in times of hormonal flux, like pregnancy, the postpartum period, and entering menopause. For fuzzy thinking, exercise, a low-fat diet, Motrin, and vitamin E may help. The best thing to do for your brain is to use it: Do crossword or Sudoku puzzles, study, read, or play chess or card games.
Treating Incontinence
Incontinence, or leaking urine, is a common problem related to aging. There are two types of incontinence, stress incontinence and urge incontinence, and both are more common after menopause.
Stress incontinence, the more common of the two, is the leakage of urine during exercise, coughing, sneezing, laughing, or bearing down on the abdominal muscles. It is caused by a weakened pubococcygeus, a muscle in the pelvic floor that contracts around the urethra to hold urine in. It may be stretched or torn during childbirth and further weakened by age. Urge incontinence is the inability to hold back urine long enough to get to a bathroom. There are an increasing number of options for treating both types of incontinence. Kegel exercises, which are performed by contracting the pelvic floor muscles as if to stop the flow of urine, can be very effective in preventing stress and urge incontinence. Biofeedback has also been shown to be effective in retraining the bladder.
There are also a number of devices that can be used to plug the urethra. Pessaries are vaginal inserts that change the angle of the urethra and prevent incontinence. (A tampon inserted before exercise can help reduce leakage, too.) Surgery is sometimes helpful, but less often than one would hope. And finally there are several new drugs for hyperactive bladder that may help.
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