“Thanks A Lot, Now I’m In Menopause!”
There are many aspects of breast cancer therapy that can result win menopausal symptoms during and after treatment. In fact, in some studies pre-menopausal women who do not recover ovarian function if lost during her treatment, actually fair BETTER than women who do. Estrogen blockade, either by blocking the estrogen receptor or its production, are many times a key component to cure. Certainly this treatment modality has very well known and common side effects including hot flashes. While certainly the goal of treatment is cure with normal life quality, these menopausal symptoms can interfere with that important aspect.
- Keep a fan with you at all times
- Drink plenty of water
- Avoid a lot of caffeine, alcohol and spicy foods
- Avoid common ‘triggers’ of hot flashes if known
Understandably, these suggestions may not even come close to addressing the issue, but it is a place to start. And, if hot flashes are not bad enough, there are other associated side effects of the antiestrogen properties of many breast cancer drugs, and the ovarian suppressive effects of chemotherapy:
- Mood changes
- Decreased Libido (sex drive)
- Weight Gain
- Increased Risk of Osteoporosis
Nonetheless, the finding of estrogen sensitivity is actually a favorable finding. In fact, recent studies of tamoxifen (an estrogen receptor blocker) has actually shown a better outcome with 10 years of treatment rather than 5 years. So quite a dichotomy: excellent treatment options filled with potential side effects. Surprisingly, at times these side effects can be so overwhelming, many (as many as 30-40%) of women who initiate therapy, do not complete even 5 years of treatment. These women have decided that the risk of a breast cancer recurrence is less than the decrease in their quality of life.
So what can be done?
- Estrogen Replacement – this is a very controversial remedy to many of these issues. Treatment with estrogen could actually stimulate dormant cancer cells and increase the risk of recurrence. Vaginal suppositories or even topical estrogen have been shown to procude a blood level of estrogen thus still producing risk. While most definitely the use of hormone replacement in the first 3 years post treatment would not be advised, it is worth a discussion if the side effects of these treatments are unbearable. In these instances, weighing the risk vs the benefit allows for an educated decision in this regard.
- Discontinuing Therapy – always a ‘last resort’, but I would not condone as a first line of treatment. Unfortunately with so much information available, many women have alread become somewhat familiar with the potential side of effects of these drugs. It is very difficult not ot have a preconceived anticipation of the side effects. My approach is to mention the potential side effects, but discourage a lot of inquiry until the treatment has been in effect for at least a month. In this way, the side effects will carry much more significance and may be better addressed.
- Integrative Medicine – modern medicine has traditionally not embraced non-medicinal treatments. More recently, however, an integrative approach has become much more a part of the overall care of cancer patients in general. This is a terrific ‘happy medium’ that migh allow for these side effects to be addressed, while continuing these treatments. Supplements, meditation and relaxation techiniques, and acupuncture have all been successfully implemented to address many of the life altering side effects. Unfortunately, many insurance companies do not cover these consultations, but it might be worth the fee and save lives.
The effectiveness of anti estrogen therapy cannot be overstressed. It is unfortunate that side effects can accompany this therapy. The overall survival improvement in estrogen sensitive breast cancer is substantial. Women need to be aware of the benefit and more importantly, aware of the avenues to address any side effect. A survivorship plan is paramount to breast cancer treatment.