Menopause After Breast Cancer

Peri-menopause can be hard at the best of times, but even moreso if you’ve had breast cancer and HRT isn’t an option. In recent years the narrative has been that HRT has protective effects after menopause that none of us should miss out on. Whilst this may or may not be true, not being able to take HRT can leave breast cancer survivors feeling more frightened of what the future holds for them. So read on to find out which HRT alternatives are safe and effective for you if you’re struggling with menopause after breast cancer.

 

What is menopause?

Menopause usually marks the first year anniversary after the last period, a definite point in time, rather like the day your periods first started. Peri-menopause is the lead up to menopause, and it has a more vague start and end date. Peri-menopause symptoms include:

• Feeling lost, disconnected or apathetic
• Fatigue
• Hot flushes
• Aches & pains
• Brain fog
• Anger or irritability
• Insomnia
• Anxiety or depression
• Vaginal dryness or loss of libido

Breast cancer survivors can struggle with menopause symptoms more than most for 2 reasons: Firstly, some may have undergone a chemical or surgical menopause to starve any oestrogen-receptive cancer cells of oestrogen. Although the symptoms are much the same as a natural menopause, it’s a huge shock to the system and another thing to cope with on top of cancer. Also in oestrogen-receptive breast cancer which is the most common form, HRT can’t be used as it will feed any dormant cancer cells.

 

How Do Breast Cancer Treatments Cause Menopause?

This section is by Dr Susanna Unsworth

The most commonly used treatments are medications that are taken daily, usually for between 5 and 10 years (or indefinitely if surgery is not an option). Generally, women who are already post-menopausal at their time of diagnosis will be offered medications called aromatase inhibitors (eg letrozole, anastrozole, exemestane). These medications prevent the body from producing oestrogen in fat tissue and adrenal tissue. They do not act on the ovary, which is why they are only used after menopause when ovarian function has stopped.

Women who are pre- or peri-menopausal will often be offered Tamoxifen. This is an oestrogen-receptor blocker, which stops oestrogen having its effect on the oestrogen receptor. It is more ‘selective’ for breast tissue, but does act on some other tissues too. However, in some situations, where the risk of breast cancer recurrence is higher, it may be recommended to stop the ovary producing oestrogen in pre- or peri-menopausal women, as this has been shown to offer a better benefit. In order to do this, women may be offered an injection that medically ‘turns off’ their ovaries. They may also be offered the option of having their ovaries surgically removed as a more definitive way of stopping the ovaries releasing oestrogen. The medications above are then used, and as the woman is now post-menopause (either surgically or medically induced), aromatase inhibitors can be used.

All of these hormonal therapies do have side-effects and risks involved in taking them. They will generally bring about menopause-like effects – hot flushes, vaginal dryness, mood changes and cognitive changes are not uncommon. Aromatase inhibitors can often cause joint pains, particularly in the hands and feet. They also impact on bone density, so it is important that this is monitored with DEXA scans. Tamoxifen has other risks, including an increased risk of clotting, along with thickening effects on the womb lining.

A new medication, known as a neurokinin receptor antagonist, has recently been developed which is a non-hormonal treatment for hot flushes – it should hopefully be available in the UK soon. Vaginal oestrogen can also be considered for a lot of women if vaginal dryness is very problematic, although it is not currently recommended alongside aromatase inhibitors.

Self-care for menopause after breast cancer

Regardless of which health condition you need help with, self care plays a very important role both in your recovery, and your long term quality of life. When we’re looking specifically at menopause after cancer, the aim is to inflammation and restore a good equilibrium for your hormones. Good diet, hydration, activity, sleep, and stress management are all key, but you’d need to choose your herbs and supplements more carefully if you’re still on medication for your breast cancer. Nutritional supplements have less potential to interact, but you need to be confident that you’re using the right supplements at the right dosage for you. A nutritional therapist will be able to help you with this.

There’s a lot of confusion amongst breast cancer survivors and Oncologists about using herbal remedies to manage menopause symptoms. Patients are often warned off taking herbs that contain phyto-oestrogens, and sometimes any herbs at all, in case they interfere with prescribed medications, or encourage the cancer to return. It’s true that certain herbs can interact with prescribed medications, but those which are safe have a vital role to play in managing menopause after breast cancer.

There are some excellent self care tips from Dr Liz O’Riordan on her YouTube channel here too.

How I Work With Breast Cancer Survivors In Menopause

As always, I look at menopause in the context of your overall health if you’ve had breast cancer in the past. During the first consultation it’s not uncommon to notice that the patient’s metabolic health and hormone balance hasn’t been ideal for quite some time. So often the body is already primed towards oestrogen excess, and then something will happen to tip the balance. One lady I met had lost her mother to breast cancer when she was a child. She remained perfectly healthy though until her partner left her when she was pregnant with their second baby. The ex-partner completely cut himself off from the family, leaving her emotionally bereft and having to raise one child whilst pregnant. She was diagnosed with breast cancer shortly after the baby was born. Her mainstream treatment was successful, and she’s remained cancer-free ever since.

We’re multifaceted beings, and each of us is a complex web of physical, psychological, emotional and spiritual factors. I believe that all illness and injury originates in the subconscious mind. Because the patterns are subconscious, we’re not aware of them day to day so we can’t take corrective action. That means it’s not our fault when our health goes wrong, but it’s our responsibility to respond to any illness in a loving way which truly supports our recovery.

Where before we used to think that genetic illnesses were unavoidable, we now know that’s not necessarily true. We’re understanding more all the time about how our diet, lifestyle and mindset influence gene expression, helping to determine whether we stay well or become unwell. This is called epigenetics and it’s really fascinating because it enables us to make wise choices when it comes to our health. This is why I incorporate health coaching to show you how to get the foundations of peak health in place, and if we need it, advanced hypnotherapy to create new subconscious patterns that will help you in future.

In terms of herbal treatment, I typically blend together around 6-7 herbs into a main mix which work synergy together. Phyto-oestrogenic herbs are usually an important part of any herbal prescription for restoring hormone balance. The difficulty is in educating patients and Oncologists about how safe and effective they can be for use after breast cancer.

Often these fears are based on misunderstanding, because the term ‘Phyto-oestrogen’ implies that the plants contain oestrogen, which is not the case. Having just been to an integrated training session on this, some Doctors really struggled with the concept that phyto-oestrogens can be safely used to manage menopause symptoms after breast cancer. That’s completely understandable because Doctors are trained in a completely different approach to treating illness and they educate their patients accordingly.

There is some evidence that certain herbs will actually help to protect breast cancer survivors from their cancer recurring. Where there is excessive oestrogen, the phyto-oestrogens in these plants will sit on the receptors and block the real oestrogen from feeding any remaining cancer cells.

Where a patient is still nervous about taking phyto-oestrogenic herbs, I don’t include them in her mix because worrying about her medicine isn’t going to help her recovery! Phyto-oestrogens are in so many foods that they’re virtually impossible to avoid anyway, but there are still plenty of other herbs we can use if we need to.

Other types of herbs I’d typically add into a prescription for menopause after breast cancer would include:

• Nervines – to work on stimulating or relaxing the nervous system, balancing mood and aiding restful sleep.
• Adaptogens – to help the body out of its stress response following the trauma of a cancer diagnosis and treatment.
• Herbs for specific symptoms, such as hot flushes, brain fog, fatigue or aches and pains.

The same protocol applies whether the menopause is natural or has been chemically induced, and all herbs are checked for potential interactions with prescribed medicines before use.

What can breast cancer survivors take for menopause?

There are so many options for managing menopause symptoms after treatment! I obviously can’t make specific recommendations for herbs here without knowing more about you, but herbal alternatives to HRT are definitely worth exploring.

If you’ve been through breast cancer, you’ve been through a huge amount of stress and trauma, and you may well be worried about the cancer returning. Advanced hypnotherapy can give you some added insight into the deep psycho-emotional reasons behind any illness, helping to restore your confidence and renew your ‘zest for life’. I use techniques with blend NLP with deep hypnosis, and another called ‘hypnohealing’ which can help to resolve physical health issues with hypnosis.

Health coaching offers both guidance needed to help you improve your diet and lifestyle, and the motivation to actually make the changes! I often find that patients still need huge amounts of moral support once treatment has ended, because everyone around them expects them to be fine. Many haven’t had an opportunity to recover from the upheaval and talk through the impact it’s made even with their close family. So a lot of my work with breast cancer survivors is simply filling that gap and offering a safe space to talk.

Where can I find out more?

My standard Menopause Rescue Programme combines 12 weeks of intensive herbal treatment with either health coaching or advanced hypnotherapy. I can also offer a completely bespoke programme if you’d like all 3.

Book a free call now to tell me what’s been going on, and we can explore your best options together.

And if you’d like to know more about mainstream menopause treatment options during or after breast cancer, contact Dr Susanna Unsworth via her website here.