Q&A Topic: Managing Menopause After Breast Cancer
Anthony C. Cahan, MD FACS
Q. Are menopausal symptoms different after breast cancer?
A. Menopausal symptoms are not different if a woman has had breast cancer. Symptoms are different for each woman, and not necessarily worse following breast cancer. A spectrum of menopausal symptoms exists for all women.
Q. Following breast cancer, is treatment of menopausal symptoms different?
A. Symptoms fall into three categories: (1) vasomotor: hot flashes and insomnia; (2) uro-genital: thinning and shrinkage of vaginal tissues, decreased lubrication, and propensity to urinary tract infections; and (3) psychological changes: moodiness, depression, withdrawal, even intellectual decline. Treating a woman for menopausal symptoms following breast cancer involves attention to very specific factors.
Q. Are hormonal treatments for symptom relief safe following breast cancer?
A. If safety is defined as not increasing the risk of recurrence or spread of breast cancer, then systemic hormonal replacement therapy (HRT) in the form of a pill or patch is safe in select cases. Women who are on certain medications, such as tamoxifen or aromatase inhibitor, cannot have HRT at the same time. As both medications decrease the stimulatory effect of estrogen on estrogen-receptor-positive breast cancer, adding estrogen through HRT lessens their effectiveness. On the other hand, for women who carry a BRCA mutation, which is associated with a higher risk of breast cancer, HRT poses no increased risk. Likewise, women who have had a bilateral mastectomy for non-invasive breast cancer or precancerous lesions can safely go on HRT. If a woman’s menopausal symptoms are exclusively uro-genital, she can safely be treated with locally applied estrogen hormone therapy.
Q. Are non-hormonal and alternative therapies safe following breast cancer?
A. Selective serotonin reuptake inhibitors (SSRI), such as Effexor, Paxil, and Prozac, can be effective in improving the psychological and vaso-motor (though not uro-genital) cluster of menopausal symptoms non-hormonally, and are considered safe following breast cancer. While alternative remedies for relief of menopausal symptoms, such as black cohosh root, acupuncture and phyto-estrogen preparations, are considered safe for women who have had breast cancer, studies have failed to show a benefit. Anecdotally, however, some women report experiencing relief from alternative therapies. My best advice to women who have entered menopause following breast cancer is to have a frank discussion of all menopausal symptoms with your breast surgeon or medical oncologist.
Anthony C. Cahan, MD FACS, has been Chief of Breast Surgical Services for The Breast Institute at Northern Westchester Hospital since 2002. His previous experience includes an internship and residency in general surgery at The New York Hospital-Cornell University Medical College, and cancer studies at Memorial Sloan-Kettering Cancer Center and Beth Israel Hospital.
Learn More About Dr. Cahan
Chief of Breast Surgical Services, The Breast Institute at Northern Westchester Hospital
Northern Westchester Hospital
Northern Westchester Hospital is a proud member of Northwell Health (formerly North Shore-LIJ Health System).