Managing menopausal symptoms

In yesterday’s post, I touched on the reason some women abandon tamoxifen – the fact that it contributes to menopausal type symptoms. Having to deal with hot flushes and other associated symptoms is not pleasant for any woman, but I think it is particularly hard for younger women to deal with. Chemotherapy put me into a temporary menopause, where my periods stopped and I experience classic symptoms such as hot flushes and night sweats. This lasted for about a year after treatment ended and my periods came back. For some women, cancer treatment may hasten an early menopause.

What is Menopause?

Menopause is the transition period in a woman’s life when her ovaries stop producing eggs, her body produces less estrogen and progesterone, and menstruation becomes less frequent, eventually stopping altogether.

Symptoms

Menopausal symptoms, including hot flushes, night sweats, generalised aches and pains, palpitations, vaginal dryness, lower sex drive, mood swings, poor concentration and other conditions, can be quite severe in some women and very mild in other women. Some women may experience anxiety and depression and it may be hard to work out if this is a menopausal symptom or due to a recent diagnosis of breast cancer.

Hot Flushes

Many women find hot flushes the most disturbing problem. The following tips might help in managing hot flushes:

• Wear cotton clothing in layers. Cotton absorbs moisture and layering allows you to remove clothing as your body temperature changes.

• Use several layers of natural bedclothes that can be removed as needed.

• Use sprays or moist wipes to help lower your skin temperature.

• Aromatherapy oils, such as cooling peppermint or relaxing lavender, may be added to the spray.

• Avoid warm areas and use an electric fan to lower your skin temperature.

• Keep a record of your hot flushes to see if there is a pattern or an association with an item such as a particular place or food, especially spicy food.

• Avoid hot baths or showers as they may trigger a hot flush.

Vaginal dryness

Low oestrogen levels can result in vaginal dryness and irritation. Wearing loose fitting cotton underwear and loose fitting trousers can help. Vaginal moisturisers such as Replens (available from chemists) may be used every few days. If you experience discomfort during sexual intercourse, water based lubricants such as KY-jelly can be used.

Mood swings

You may find that you are experiencing extreme mood swings from very happy to very sad. These can happen unexpectedly and for no apparent reason. Relaxation classes, meditation, yoga and similar activities can be a useful way of controlling mood swings. Sometimes joining a support group where you can talk to other women with similar experiences can help. If you find you cannot cope with your mood swings talk to your doctor or breast care nurse. They may refer you to a counsellor or therapist who can help.

HRT

HRT replaces the hormones that are no longer being produced by the ovaries. This is a very effective way of relieving menopausal symptoms. However, women with a history of breast cancer should try other treatments to relieve symptoms before trying HRT.

Anti-depressant drugs

There is some evidence that the anti-depressant drugs venlafaxine and fluextine can be effective in controlling hot flushes for some women.

Clonidine

This drug, mainly used to control high blood pressure, has been shown to be effective in reducing both the number and intensity of hot flushes.

Low dose progesterone

Progesterone in low doses is effective in relieving hot flushes. Megestrol (megace) and medroxyprogesterone (provera) are the most common drugs prescribed.

Other medications

Postmenopausal osteoporosis is a condition that is caused by low levels of oestrogen. It causes bones to become brittle and may result in fractures (broken bones). Selective oestrogen receptor modulators (SERMs), such as raloxifene are used to try to prevent osteoporosis. They do not lessen the other symptoms of menopause. Bisphosphonates are also used to try and prevent osteoporosis but again do not relieve other menopausal symptoms.

Non-prescription interventions

The following items do not require a prescription. However, you should not take any of the preparations listed below without discussing them with your cancer specialist or GP.

Vitamin and mineral supplements

Vitamin E, selenium and vitamin B6 have provided relief for some women. Calcium and vitamin D supplements can help strengthen bones. Never take more than the recommended dose of supplements.

Evening primrose oil

Many women find evening primrose oil helpful. It may take many months before any improvement is noticed.

Phyto-oestrogens (plant oestrogens)

Phyto-oestrogens are thought to relieve menopausal symptoms by mimicking the effects of oestrogen in the body. They are found in most soya foods, especially soya beans, linseed, whole grains, fruits and vegetables.No clinical trials have been conducted on phyto-oestrogens so it is unknown if they could increase the risk of your cancer coming back.

Complementary therapies

Many women use a range of complementary therapies to reduce the symptoms of menopause. These therapies include acupuncture, reflexology, massage, meditation, aromatherapy and homeopathic and herbal remedies. If you decide to use complementary therapies, it is important that you go to a recognised, qualified practitioner. Always discuss complementary therapies with your cancer specialist or GP before starting any therapy.