Managing Menopause After Breast Cancer

Coming off of birth control with acne-prone skin

For so long breast cancer was thought of as a disease that affected our mothers and grandmothers; often later in life, often after they had gone through menopause. Yet we’re seeing that while the incidence of breast cancer in women over the age of 50 is stable, the number of women being diagnosed before the age of 50 is increasing. Currently it’s estimated that around 25% of women diagnosed with breast cancer are pre-menopausal. This is an important reminder that if you were diagnosed with breast cancer at a younger age, you’re not alone and you’re not without resources. Today, more and more women are being faced with the question of whether they can manage their menopausal symptoms safely, or whether they have to just tough it out.

So let’s start with a few key things to remember when talking about menopause after breast cancer:

Not all breast cancers are hormone-sensitive
While breast cancer and treatment can cause menopause-like symptoms, they can also push you into menopause earlier than you expected
There ARE safe ways to treat your symptoms but not all natural therapies are safe to use if you have a history of breast cancer

Am I Going Through Menopause?

While some women go through menopause with little or no symptoms at all, other women experience a myriad of symptoms. These can include:

Physical: Hot flushes, night sweats, heart palpitations, irregular periods, lower libido, vaginal dryness
Psychological: Insomnia, forgetfulness, anxiety, irritability, mood swings, irregular sleep patterns and/or sleep disruptions
Long-term changes: After menopause, the subsequent drop in hormone levels also alters metabolism and can result in women gaining weight in other parts of their body (such as the lower abdomen or thighs). The low estrogen also increases women’s risk of osteoporosis and cardiovascular disease.

Are My Symptoms Breast Cancer-Related?

What makes menopause a little more confusing if you have a history of breast cancer is that it can be difficult to distinguish between ‘normal’ menopausal symptoms and symptoms that have been brought on or made worse by their cancer or medications.

In women with a history of breast cancer it’s common to see a number of menopause-like symptoms, even in the absence of menopause:

Hot flushes and night sweats (up to 80% of women with breast cancer will experience this)
Urogenital changes such as vaginal dryness, itching, and painful sex (especially common in women on aromatase inhibitors, estimated to impact 50-70% of women taking these medications)
Worsening anxiety and depression

It has also been shown women diagnosed with breast cancer at a younger age are more likely to experience a higher number of physical symptoms, mental-emotional distress, and poorer sexual functioning (compared to women who are older upon diagnosis).

Other Things to Consider

If you are experiencing symptoms of menopause it’s important to determine whether these are the result of menopause or your cancer history. It’s not uncommon for these causes to overlap, but getting a sense of exactly what is happening is the first step, as it gives us a much clearer direction when we move forward with treatment.

If your symptoms are the result of cancer and/or treatment: we can expect that your symptoms may need management for as long as you are on estrogen-suppressing medication (such as tamoxifen and aromatase inhibitors, which are given to women who have estrogen-dependent cancers). It’s been estimated that up to 20% of women with breast cancer consider stopping or stop hormone therapy because of their menopausal symptoms. Giving women options before they feel that they need to make this tough choice is fundamental to providing effective and safe care.
If your symptoms due to menopause: whether menopause began naturally or was brought on by treatment, your timeline may be a little more vague. However, I always remind women that changes occurring as a result of menopause can last longer than expected, so I always ensure that you are properly supported throughout the entirety of this time.

My Breast Cancer Is Hormone Receptor Positive. How Do I know What’s Safe?

A history of breast cancer does NOT mean you have to suffer without support, or that you cannot take steps to manage your menopause. What it does mean is that you need to find the right Naturopathic Doctor to support you, someone who is not only comfortable treating menopause, but is well-versed in breast cancer.

However, there are natural treatment options I absolutely avoid in women with a history of breast cancer. These often vary depending on what type of cancer you had, whether you are currently being treated with medication, and how severe your menopausal symptoms are. However, I always advise avoiding herbs that directly alter levels of estrogen / progesterone, such as:

Licorice root (glycyrrhiza glabra)
Hops (humulus lupulus)
Chastetree (vitex agnus castus)
Red clover (trifolium pratense)

So What can I do about My Menopausal Symptoms Now?

Unlike a daily pill, naturopathic medicine addresses how women choose to eat, move, and care for themselves in their daily lives. It is the culmination of these daily habits that ultimately helps keep hormone levels balanced, to reduce, or even eliminate the symptoms of menopause. So let’s start with a few things you can do safely, at home:

Sugar. Cutting out excess sugar not only helps to keep your blood sugar levels balanced but has been shown to reduce the intensity of menopausal symptoms (hot flashes, night sweats, insomnia, etc). Additionally, the stable blood sugar levels that come from cutting sugar out of your diet also helps to protect you from cancer recurrence, making this a great way to feel better now and protect yourself later. (NOTE: consider switching in dark chocolate (70% or more) - research has found a connection between consuming dark chocolate regularly and improved vascular endothelial function in postmenopausal women, which helps to support healthy blood pressure.)
Soy. Soy has been a controversial topic for anyone with a history of breast cancer as it was thought that because soy is a phytoestrogen it would increase the body’s overall estrogen levels and potentially stimulate breast cancer development. However, in recent years it’s been shown that these phytoestrogens actually protect the body from excess estrogen and help to balance drops in estrogen. This makes soy both protective against breast cancer recurrence and useful for improving symptoms of menopause, which are caused by the drop in estrogen. There are supplements with soy isoflavones available, but I prefer to have people add soy to their weekly diet instead. 5-7 servings of soy weekly is sufficient to help treat breast pain, prevent hot flashes after treating breast cancer, menstrual symptoms, and premenstrual syndrome (PMS). Not convinced? Here are a few other important benefits of soy:
Alcohol. With hot flashes and insomnia being two of the most common problems women face as they go through menopause, it’s important to consider cutting it out or significantly reducing how much and how often you drink. Alcohol often worsens the intensity and frequency of hot flashes and we know that it can increase a woman’s risk of breast cancer, as alcohol alters both your estrogen and progesterone levels. However, alcohol also directly impacts your melatonin levels, which is the hormone responsible for regulating your sleep-wake cycle. It’s been shown that 2-3 drinks can lower melatonin levels by up to 19%, making it harder to get restorative, sustained sleep at night. If you’re struggling with menopausal symptoms do your best to stay away from alcohol completely so you can enjoy restful sleep cycles and less intense hot flashes.
Activity. I know that if you’re already feeling feeling fatigued and are struggling with hot flashes, you may not feel very motivated to exercise. However, consistent exercise will stabilize your energy levels, improve your sleep, and reduce the intensity of those nasty hot flashes. If you’re on an aromatase inhibitor, exercise is even more vital as it helps build bone mass which will offset your increased risk of osteoporosis (without the need for any more medications). Additionally, in women with a history of breast cancer exercise also helps to reduce the risk of recurrence and increases survival. Choose an activity you enjoy that gets your heart rate up a little and aim for at least 4 hours per week. Need ideas? Consider:
- Walking (moderate aerobic activity): 15 minutes of moderate-vigorous walking 3-7 times per week has been shown to reduce hot flashes in research studies; additionally a study of 3000 women with a history of breast cancer found that those who walked 3-5 hours per week at a moderate pace had significantly increased survival rates
- Yoga: Hatha yoga was used in one study, and it was found that 1-2 classes per week improved hot flashes, anxiety, depression, and helped to balance reproductive hormones
Mindfulness. We hear about meditation a lot these days, and for most people it’s a really challenging daily habit to adopt. However, if you are struggling with symptoms of menopause I think this a wonderful time to give it a try, as you can expect to see improvements in 1 week! After 8 weeks you should see maximum benefit, which can be sustained for as long as you continue your practice. Here are a few ways to incorporate a mindfulness practice into your life:
1. Body scans: this can take anywhere between 1-10 minutes, depending on how slow you want to go. To do a body scan start at your head and gradually move your attention through all areas of your body until you reach your feet. This can be done sitting or lying down and the primary thing to focus on as you do this is bringing your awareness to your bodily sensations. Instead of trying to change anything, this practice is one of simply noticing.
2. Traditional meditation: there are so many wonderful apps you can download on your phone that will walk you through a meditation practice. These can be very helpful if you are new to meditation and find it hard to focus. However, there’s no wrong way to meditate! If you need a place to start, sit comfortably and focus on your breath, observing the flow of air in and out of your body, paying attention of any sensations, thoughts, or emotions that arise. Allow yourself to notice and experience them without any judgement. Don’t set a timer or put pressure on yourself to do this for a long time, just start where you’re at.
3. Mindful movement: if sitting still and being in your own head sounds anything but relaxing, consider mindful stretching instead. Mindful stretches are gentle exercises that have been designed to help you develop awareness of your body as you work through movement. This is often a great option if you need a break from a desk job, find you have too much restless energy to sit still for a prolonged period of time, or just want to add a relaxing end to your regular workouts.

Next Steps

Want more support? Choosing herbs, supplements, and more targeted treatments needs to done be done on an individual basis, taking into consideration your whole health history. I want your treatments to not only be safe but to have as many positive effects on your health as possible. For this reason, I avoid anything that may increase your risk of cancer recurrence, instead opting for treatments that not only improve your menopausal symptoms but support long-term remission. Naturopathic medicine is not about over-complicating your life, but empowering you so you can make smart, safe choices that you feel good about.

Ready to make a change?

Menopause can be a challenging time for anyone. When it comes to your health, it’s important to be your own advocate AND have a doctor that will advocate for you. If you are in search of more direct and personalized ways to reduce your symptoms don’t be afraid to reach out and ask. I can help .

In support of your health,

Dr. Hayhlee Clarence, ND

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