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

Hot flashes, night sweats, aches, pains and mood swings. Breast cancer hormone therapy can result in menopausal side effects like these. Here are some tips for managing them and improving your quality of life.

Around 75 percent of breast cancer tumors are stimulated by female sex hormones – mainly by estrogen, but sometimes by progestogens too. Hormone-dependent cancers are therefore usually treated with anti-hormones. Depending on the medications prescribed, they either block the effects of these sex hormones or prevent the ovaries from producing them.

The problem is that there are breast cancer hormone therapy side-effects. Many women transition into menopause almost overnight, with all its accompanying symptoms, including hot flashes, joint pain, dry mucous membranes and mood swings. It can even cause menopause symptoms to return in older women. Although the side effects of hormone therapy cannot be eliminated, there are things you can do to better cope better with menopausal symptoms.

 

What you can do about common menopausal symptoms

Hot flashes

Hot flashes and night sweats are among the most common side effects of hormone therapy after breast cancer. These can vary from happening a few times a day to several times an hour. Some women feel mild heat in the face while others experience palpitations and drenching sweat all over the body. They happen because our heat center in the brain depends on estrogen. When our estrogen 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. These episodes are known as hot flashes. 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 sweating when you’re out and about. Some find that alternating hot and cold water in the shower helps.
• Wearing light layers of clothing allows you to 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 Behavioral Therapy (CBT) to reduce hot flashes. Research finds that being able to manage your emotions and feelings helps reduce physical symptoms. Exercises such as yoga, breathing training or hypnosis also provide relief.
• If your symptoms are severe, talk to your doctor about medication that may help. Some anti-depressants have been shown to reduce hot flashes. They interfere with metabolism and regulate body temperature. But be aware that they usually take a few weeks to work, and they have side effects, including nausea and tiredness.

Things to keep in mind

• Stimulants, such as spicy foods, hot drinks, alcohol, and smoking can make hot flashes worse. Keep a diary to help identify your triggers and things to avoid.
• It doesn’t help to drink less. Drinking fewer fluids won’t reduce the sweating. Dehydration can even make hot flashes worse. Drinking cool water can cool down your body and keep your circulation in balance.

 

Muscle and joint pain

A lower level of estrogen in the body can affect how minerals are absorbed. It can lead to an increased risk of osteoporosis and weaker bones. Side effects such as 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 walking, aerobics, Tai Chi, tennis and dancing. Ask your breast care nurse for advice on choosing an activity that suits you. They may have a list of classes in your area.
• 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 & seeds, and dried fruits. Some breakfast cereals, bread and mineral water have extra calcium.

Vitamin D3 is needed to absorb the calcium from the food. Your body makes vitamin D3 from sunlight. 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 medications work by moving calcium cells from your blood into your bones, keeping them stronger, longer.
• A balanced diet and a healthy weight have many health benefits. If you have gained or lost weight, talk to your doctor or breast care nurse. They can give you advice on choosing a program that is suitable for you and can refer you to a dietician if necessary.

Things to keep in mind:

• Drinking too much alcohol (over 14 units/week) can affect your bone density. Smoking is also linked to a higher risk of fractures (broken bones). If you are a smoker, quitting is ideal (talk to your doctor or visit com for support), but even cutting down can help.

 

Vaginal Dryness

Among other things, estrogen 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 makes sexual intercourse uncomfortable and increases the risk of infections.

Things that can help:

• Vaginal moisturizers help rehydrate the walls of the vagina. They 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 lubricants are generally designed for use during sex and are shorter acting than moisturisers. They are usually water or oil based. Some can cause irritation so you may need to try a few to find one that suits you.
• Some specialist teams consider the use of estrogen applied directly to the vaginal area as a ring or cream. This will depend on the type of tumor, and the medication you are on since as a small amount of estrogen is absorbed by the body. Ask your breast care nurse if this would be suitable for you.

Things to keep 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 medical team can give advice specific to you.

 

Mood Swings

Mood swings are common breast cancer hormone treatment side-effects. We do not know exactly how estrogen deficiency causes them. But the guess is that it disturbs a part of the brain, the limbic system, which 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 visualization) or movement exercises (yoga or tai chi) help reduce levels of stress hormones in the body.
• If your diagnosis and treatment are making you feel extremely anxious or depressed, ask your doctor for a referral to a professional therapist or psychologist. Your breast care nurse can give you information about the services available near you. Your doctor may also recommend antidepressants, which can be effective in the short term.
• A balanced diet and gentle exercises like walking or swimming can help balance your mood and help you feel better overall.

Things to keep in mind:

• • Research suggests that foods like soy, chickpeas and linseeds contain phytoestrogens can reduce hot flashes. While it is safe to include these foods in your diet, using phytoestrogen supplements is not recommended.

 

Useful Links:

•  Young Survival Coalition: Early Menopause
  https://www.youngsurvival.org/learn/living-with-breast-cancer/quality-of-life/managing-side-effects/early-menopause
• American Cancer Society: Sex and the Woman with Cancer https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer.html
• Living Beyond Breast Cancer: Menopausal Symptoms http://www.lbbc.org/learn/side-effects/menopausal-symptoms