Supporting People with Breast Cancer 2012

Managing Menopausal Symptoms in Younger Women

Emily O’Donovan – Clinical Nurse Specialist Breast Care

Welcome

• Brief Introduction•Short presentation; including menopausal symptoms and possible coping mechanisms•Group discussion and experiences

Menopause

• Natural and inevitable event in all women's lives• Menstruation stops and the ovaries cease

production of oestrogen and progesterone• Average age of menopause in Ireland is 50 years• Many women go through menopause gradually

and are ‘perimenopausal’ over many months• Other factors can induce early or premature

menopause Women’s Health Council 2008 (www.dohc.ie)

Factors influencing Menopause during Cancer Treatment

• Chemotherapy• Ovarian Ablation• Hormone Therapy• Radiotherapy• Surgery

These treatments can make cause menopausal symptoms to start quite suddenly

Symptoms• Menstruation ceases (permanent or temporary)• Hot flushes /Night sweats• Vaginal dryness• Reduced libido• Mood changes• Changes to skin and hair• Anxiety • Sleep disturbance, strange dreams, insomnia• Difficulty with concentration and memory• Joint aches and pains

Hot Flushes

• This is the most common menopausal symptom associated with breast cancer treatment

• Vary in frequency and intensity, some women have associated palpitations

• Cause night sweats- which can be disruptive to sleep

• Flushes have triggers such as hot showers, spicy food, anxiety or upset

• The intensity of flushes may decrease in time

What may help…

• Wear layers of clothes, especially when out and about (natural silk or cotton fibres help)

• Use layers of bedclothes an keep a spare pillow nearby

• Drinking cool water• Use a cooling spray or moist wipes• Small or desk fans• Cooling pads under prosthesis or BodiCool

prosthesis

What may help…

• Wearing scarves instead of hairpieces or partial hairpieces with hats

• Keep a diary or note of triggers and try to avoid these when possible

• Exercise – this produces natural endorphins and is often a good way to get some fresh air

• If taking Tamoxifen (20mg) try taking half in morning and half in evening.

Vaginal Dryness

• This is caused by low levels of oestrogen• It can cause pain and irritation• Dryness can contribute to already reduced libido• Distress caused by vaginal dryness can be hard to

discuss; even with a partner or health care professional.

What may help…• Vaginal lubricants can be water based (KY, Astroglide) or

oil based (such as Yes or baby oil). Oil based can be longer acting

• Vaginal moisturisers (Replense or Senselle) are available in pharmacies and can last a few days

• If you can get past the problem of the dryness, intercourse can help blood flow to the area and improve elasticity

• Always rule out any infection if symptoms change• Discuss oestrogen pessaries or creams with you medical

oncologist

Reduced Libido

• When women are diagnosed with cancer they may loose interested in sex for many reasons; both physical and emotional

• Menopausal symptoms • Pain, > 60% of women experience pain during sex after

breast cancer treatment• Change in body image, self esteem and confidence• Fatigue• Meeting a new partner

What may help…

• There is no right time to talk to a partner about this, no matter how long you have known each other

• Re-familiarise yourself with your body • Try to talk to your partner about any fears you may

have• Look at it as part of your recovery, try to think and

talk about it like you did treatment

Mood Changes

• Brain function can be affected by oestrogen levels• This can result in poor concentration or forgetfulness• Moods can fluctuate from high to low and vice versa, very

quickly• Try to see if there are any stressful triggers you can

identify• Think of activities which help you relax or improve your

mood• Exercise can help release endorphins (‘happy hormones’)

Sleep Disturbance

• Sleep can be disturbed by physical changes in the body like hot flushes and emotional causes too

• Many women experience strange dreams or nightmares

• Insomnia is a common menopausal symptom and many women report loneliness at this time

• Try to spend time relaxing before bed• Have a change of clothes/ pillow near by

Joint Pain

• Joint pain can be caused by lower levels of oestrogen

• It can occur when you are given Zoladex• It is more commonly associated with older women

who are taking aromatase inhibitor rather that younger women taking Tamoxifen

• Talk to your medical oncologist if you are concerned about osteoporosis

Relaxation• Many women find that reducing stress may help

symptoms less severe• Relaxation, whether it is on your own or with the help of a

CD/DVD may help• Professionals are available to help with dealing with

anxiety –many patients fine Cognitive Behavioural Therapy (CBT) helpful (ARC or psycho-oncology services

• Simple things such as lavender and a quiet room can help• Allowing your time to relax is important – again, look at it

as an important part of your recovery

Complementary Therapies

• Relaxation• Reflexology• Aromatherapy• Massage• Meditation • There is little evidence about the use of

complementary therapies and you should always talk to your medical oncologist and therapist before commencing treatment

Non-prescription Medications

• Many women find evening primrose oil helpful in reducing menopausal symptoms

• Interesting Vitamin E and Black cohosh are not recommended in the UK due to conflicting evidence in research; it is not discouraged in Ireland

• Phyto-oestrogens are naturally occurring in many plant products (linseed and soya) and again evidence supporting its use can be conflicting

Prescription drug therapies • Anti- depressant drugs have been found to reduce the

severity of hot flushes for some women (e.g. Effexor). It is a lower dose than when it is given as an anti-depressant so it is unlikely to effect mood or libido directly.

• Some anti-epileptic medications (e.g. Gabapentin) can be prescribed to help regulate sleep

• Medications used to reduce blood pressure (e.g. Clonadine) can also reduce hot flushes

• Low dose HRT can be considered• Any medication should be discussed with your medical

oncologist

Exercise

• Current research suggests that exercise can help prevent recurrence

• It is widely known to increase endorphins• It can be free – taking time out for a walk• Pilates or Yoga can also help to relax• Setting yourself a challenge can boost your self

esteem• Exercise with other people can be a good form of

support