Many women suffer from menopausal symptoms when taking hormone therapy. What you can do about it.

Hot flushes, night sweats, aches and pains, mood swings – hormone therapy for breast cancer can bring on these and other symptoms of the menopause. We have some tips on managing them and improving your quality of life.

 

Around 75 per cent of breast cancer tumours are stimulated by female sex hormones – mainly by oestrogen and sometimes, in part, by progestogens. Hormone-dependent cancers are therefore usually treated with anti-hormones. Depending on what medications are prescribed, they either block the effects of these sex hormones or prevent the ovaries from producing them.

The problem is that this brings many women into the menopause almost overnight – with all its accompanying symptoms, including hot flushes, joint pain, dry mucous membranes and mood swings. It can also cause menopause symptoms to come back in older women. The good news is that although the symptoms cannot be eliminated, there are tricks to help you cope with them.

 

What you can do about common menopausal symptoms

 

Hot flushes
Hot flushes and night sweats are among the most common complaints after breast cancer treatment. These can vary from happening a few times a day to several times an hour and from mild heat in the face to palpitations and drenching perspiration all over the body. They happen because the heat centre in the brain is dependent on oestrogen. When our oestrogen level drops, the nervous system causes the blood vessels in the skin to expand. As a result, the skin is supplied with more blood and the body releases excess heat to the outside – as a hot flush. The sweat then cools the skin, causing the body temperature to drop.

 

Things that can help:

• Water sprays and fans can be your best friend. They’re small enough to fit in your bag or pocket and can help during acute sweats when you’re out and about. At home, some find that alternating hot and cold water in the shower helps.
• Wearing light layers means you can take clothes off and put them back on quickly as your body temperature changes. Loose fitting clothes and natural fabrics can also help reduce sweating.
• Studies are being carried out on Cognitive Behavioural Therapy (CBT) to reduce hot flushes, as it has been found that being able to manage your emotions and feelings helps reduce physical symptoms. Exercises such as yoga, breathing training or hypnosis also help.
• If you are having severe symptoms, talk to your doctor about medication that may help. Some anti-depressants have been shown to reduce hot flushes. They interfere with the metabolism and regulate the body temperature. However, they usually take a few weeks to work and they can have side effects, including nausea and tiredness.

 

Things to bear in mind:

• Stimulants, such as spicy food, hot drinks, alcohol and smoking, can make hot flushes worse. Keeping a diary can help identify your triggers and things to avoid.
• It doesn’t help to drink less. Taking in less fluid won’t reduce the sweating, and dehydration can even help make the hot flushes worse. Drinking cool water can help cool the body and keep the circulation in balance.

 

Muscle and joint pain

The lower level of oestrogen in the body can also affect how minerals are absorbed, leading to an increased risk of osteoporosis and weaker bones. Aches and pains in muscles and joints can accompany this.

 

Things that can help:

• Weight-bearing exercises strengthen your bones by putting pressure on them. These include activities such as brisk walking, moderate-resistance weight lifting, stair climbing, exercising with resistance bands, tai chi, tennis and dancing. Ask your breast care nurse or practice nurse for advice on choosing an activity that suits you – they may have a list of classes in your area.
• Ensure that you get enough calcium and vitamin D3. Calcium is vital for bone health and is found in foods such as milk and dairy products, green leafy vegetables, fish, nuts and seeds, and dried fruits. Some breakfast cereals, breads and mineral water have extra calcium added.
• Vitamin D3 is needed to absorb the calcium from the food. Your body makes this from sunlight, and it can also be found in foods such as oily fish and egg yolks.
• If you are diagnosed with osteoporosis, your doctor may prescribe medication such as bisphosphonates. These work by moving calcium cells from your blood into your bones, keeping them stronger for longer.
• A balanced diet and healthy weight has a lot of health benefits. If you have gained or lost weight, talk to your GP or breast care nurse. They can give you advice on choosing a programme that is suitable for you and can refer you to a dietician if necessary.

 

Things to bear in mind:

• Drinking too much alcohol (over 14 units a week) can affect your bone density, and smoking has also been linked to a higher risk of fractures (broken bones). If you are a smoker, quitting is ideal (talk to your GP or visit the NHS website at nhs.uk/smokefree for local support), but even cutting down can help.

 

Vaginal dryness

Among other things, oestrogen ensures that the mucous membrane of the vagina is well supplied with blood and becomes moist with sexual arousal. If the production of the hormone is stopped or blocked, it can cause vaginal dryness and irritation. This can make sexual intercourse uncomfortable and increase the risk of infections.

 

Things that can help:

• Vaginal moisturisers help rehydrate the walls of the vagina and can not only make sexual intercourse more comfortable, but also help with daily dryness and discomfort. Most work best when applied regularly every few days.
• Vaginal lubricators are generally designed for use during sex and are shorter acting than moisturisers. They are usually water- or oil-based. Some can cause irritation and you may need to try a few to find one that suits you.
• Some specialist teams consider the use of oestrogen applied directly to the vaginal area as a pessary or cream. This depends on the type of tumour and the medication you are on, as a small amount of oestrogen is absorbed into the body. Ask your breast care nurse if this would be suitable for you.

 

Things to bear in mind:

• Fragranced soaps or lotions can make the irritation and dryness worse.
• Hormone therapies such as tamoxifen and other breast cancer treatments can cause your periods to stop. However, you may still be fertile and need to use contraception. Your GP or medical team can give advice specific to you.

 

Mood swings

It is not known exactly how oestrogen deficiency causes mood swings. It is believed that it disturbs the part of the brain – the limbic system – that is responsible for processing our emotions. This can result in emotional peaks, low moods and, for some women, depression.

 

Things that can help:

• Relaxation techniques such as mind exercises (meditation or visualisation) or movement exercises (yoga or tai chi) help to reduce the level of stress hormones in the body.
• If your diagnosis and treatment are making you feel extremely anxious or depressed, you can ask your GP for a referral to a professional therapist or psychologist. Your breast care nurse or key worker can give you more information about the services available near you. Your doctor may also recommend antidepressant tablets, which can be very effective in the short term.
• As well as helping you feel better generally, a balanced diet and gentle exercise like walking or swimming can help balance your mood.

 

Things to bear in mind:

• Foods like soy, chickpeas and linseeds contain phytoestrogens which, research suggests, can reduce hot flushes. While it is safe to include these foods in your diet, using phytoestrogen supplements is currently not recommended.

 

Useful Links:
Cancer Research UK: Breast Cancer and Menopausal Symptoms
Breast Cancer Care: Menopausal Symptoms and Breast Cancer pdf
Macmillan Cancer Care: Breast cancer and the menopause