Menopause is a very natural part of life and, just like getting your periods, it’s something all women go through. But each woman’s experience of menopause and menopause symptoms is different. For women going through breast cancer the onset can be sudden, and the symptoms more severe.
In part one of this series, we talked about oestrogen and why menopause symptoms can be so severe for breast cancer patients. In part two we are going to look at the symptoms that cause the most concern and look at some things that you can do to help yourself and where you can go for help.
Hot Flushes and Night Sweats
Hot flushes and night sweats are probably the most common symptom associated with menopause. Hot flushes come and go and the severity and duration varies between women. Although we don’t know exactly what causes hot flushes it is generally understood that it is the rate of change of oestrogen levels rather than lower circulating levels that lead to hot flushes. It is thought the reduction in oestrogen resets the central temperature control system in a region of the brain called the hypothalamus – much like resetting the thermostat on central heating. This resetting results in a much smaller core body temperature range where the body doesn’t have to actively regulate. This means that a hot flush can be triggered by just a small change in body temperature. These changes could be caused by changes in the ambient air temperature, rushing, having a hot drink or being stressed. We then sweat and try to cool down when faced with these small temperature changes. Whilst some people can identify clear triggers for hot flushes, not all flushes have specific triggers and some just come on without warning.
Hot flushes and night sweats are often more severe amongst breast cancer clients due to the rapid reduction in oestrogen levels due to treatments and can be associated with sleep problems and reduced health-related quality of life problems. Although we don’t know how to stop hot flushes there are some things you can do to help manage them:
- Wear natural fibres like cotton clothes and use cotton sheets. Natural fibres help absorb sweat.
- Dress in layers so you can easily take an item off when you experience a flush.
- Reduce your intake of caffeine, alcohol, hot drinks and spicy food.
- Have a small fan at work and/or keep a small fan running when you sleep.
- Keep a small fan in your work area and drink cold water to cool you down
- Try to reduce your stress levels. Consider yoga, meditation or relaxation techniques.
- Consider other lifestyle strategies like healthy diet and regular exercise.
It is important to note that some complementary therapies such as black cohosh and phytoestrogens are usually not recommended for women who have had breast cancer. If you’d like to find out more about herbs and other dietary supplements click here.
There is more that can be done to manage hot flushes. There has been some great work done with cognitive behavioural therapy and managing hot flushes as well as other drugs that can be prescribed for breast cancer clients. You can talk to your breast care nurse and they may be able to refer you for further assistance.
Painful joints can be a problem associated with menopause and it can also be a side effect of drugs used to treat breast cancer. Oestrogen helps control joint inflammation and it also helps regulate the level of fluid within the joint. This affects the hydration and lubrication of joint tissues including cartilage, ligaments and tendons. Joints that may have already been showing wear and tear may become more painful during menopause or breast cancer treatment.
Things you can do to manage joint pain:
- Eat anti-inflammatory foods, like blueberries or herbs and spices such as turmeric, ginger, cinnamon and garlic. Also foods that are rich in Omega 3s such as fatty fish, leafy greens nuts and, yes chocolate.
- Limit your intake of foods that may trigger joint pain such as citrus fruits, caffeine, tomatoes, sugar and salt.
- Exercise – regular, low impact exercise helps keep your joints lubricated and strengthens muscles surrounding and supporting joints.
- Manage your weight – excess weight means more pressure on your joints so even a small decrease in weight can increase mobility and relieve pain.
- Drink lots of water. It will help keep tissue moist and supple. Our bodies don’t retain water well during menopause so it’s important to replace what is lost.
- Ice – when there is inflammation Ice can help relieve the pain. 20 minutes will help reduce any swelling but make sure you don’t apply it directly to the skin. Wrap it in a thin towel.
- There are a variety of supplements that may help including magnesium, glucosamine and chondroitin.
It is important to get your symptoms checked by your doctor. This will make sure that there isn’t something else at the root of your pain, like arthritis or osteoporosis.
With any major transition in our lives there is potential for sadness, grief and mood changes but when you combine breast cancer and menopause it’s hardly surprising that it is something many women struggle with.
For someone facing breast cancer, not only are you dealing with the emotion of your diagnosis which can include anxiety about body, health, relationships and finances, menopause or menopause symptoms can bring their own stresses, like uncertainty of ageing, fertility issues, and the uncomfortable and disruptive symptoms. There is so much going on that sadness and grief are a very natural and expected response.
The mood changes and irritability associated with menopause are another thing altogether. Mood can be affected by many things from an argument with a loved one to a traffic jam to not being able to find your keys. It’s not always clear what causes them but it is thought oestrogen has a role. Oestrogen helps regulate mood-boosting hormones such as serotonin, norepinephrine and dopamine. It also helps with cognition so a lack of it can also lead to the ‘fuzzy brain’ and forgetfulness as well. No, you are not going insane, it is your hormones!
Some of the things you can do to reduce or diminish mood swings relate to trying to improve those hormone imbalances.
- Get aerobic exercise. Exercise and physical activity releases endorphins and other feel-good hormones in the brain. You don’t have to train like an Olympian – even a brisk walk can have mood-changing results.
- Eat healthy food. It’s just as good for your mood as it is for your body to eat a varied diet with lots of fruit, vegetables, lean protein and whole grains.
- Let go of stress. We can’t always avoid stress but we can learn how to let it go. It might be as easy as reading a book, gentle yoga, meditation or a quiet walk (exercise again) to help improve mood.
- Get enough sleep. We all know that disturbed sleep or not enough sleep can lead to irritability. Try to create a sleep routine to help you get off to sleep including reducing caffeine intake, reducing ambient light, keeping your room cool and leaving all devices out of the bedroom.
It is important to realise when mood swings maybe something more. If you’re experiencing feelings that are overwhelming you or interfering with your daily activities, talk to your treatment team. As well as our team you can contact your GP for support or ask for a referral to the Menopause after Cancer Clinic at King Edward Memorial Hospital.
Sexuality, libido and vaginal dryness
It’s one of those things that we don’t talk about often enough – the effect of breast cancer treatment and menopause on your sexuality. If you have breast cancer and are going through treatment it can affect your body image and your overall sense of femininity. When you combine that with all those other menopause symptoms like hot flushes, sleep disturbances, mood changes and fatigue it’s hardly surprising that you may have decreased desire for sexual intimacy. But decreases in sexuality, libido and particularly vaginal dryness have a direct connection with menopause.
The decrease in oestrogen that occurs with menopause and cancer treatment can result in vaginal dryness and loss of vaginal elasticity that can make sex uncomfortable or painful. Unlike hot flushes, vaginal dryness does not improve with time and may be a long-term problem unless treated.
Some women say it takes longer to become aroused and experience orgasm during and after menopause. The loss of desire and libido may be directly related to lower levels of the hormones oestrogen, progesterone or testosterone. Vaginal dryness and pain may further increase the problem.
There are a number of practical and lifestyle remedies that can help manage vaginal dryness. The most effective solution is to use products that will add moisture to the vaginal tissue. There are three types that are applied directly to the vagina.
- Non-hormonal moisturisers. These come in semi-liquid form and are usually applied twice a week. They are available over the counter from most pharmacies.
- Vaginal gels and lubricants. Vaginal pH-balanced gels are used to prevent and treat vaginal dryness and have a pH similar to that of normal vaginal discharge. Vaginal lubricants are used to enhance the comfort and ease of sexual intercourse. Choose water-based or silicone-based lubricants as oil based may increase the risk of yeast infections. Both these products are available over the counter from pharmacies.
- Vaginal oestrogens. These are creams, rings or tablets that contain low doses of oestrogen that are inserted directly in the vagina. They are designed to reduce vaginal dryness and discomfort with sex. Whilst it has not been shown that vaginal oestrogens affect the risk of breast cancer recurrence they should only be prescribed by a medical practitioner who is aware of your history of breast cancer.
Other things you can do to help manage the symptoms:
- Avoid substances that may cause irritation or dryness. Wash the vaginal area with water and/or soap-free products. Avoid soap or products with alcohol or perfumes.
- Wear cotton underwear and avoid nylon underwear, tight underwear or tight clothing.
When it comes to decreased libido or discomfort during sex one of the most important things is to discuss it with your partner. Try downplaying the importance of sexual intercourse and orgasm, at least for a while. You can try simple strategies like changing position for sex or exploring other ways to be intimate so you and your partner can maintain a pleasurable and satisfying sexual relationship.
Itchy skin is another common symptom of menopause and breast cancer treatment. Once again it is oestrogen or the lack of it that seems to be the main cause of this. This is because oestrogen plays in important role in skin health. It helps the skin to stay moisturised by stimulating the production of natural oils and collagen. Collagen is a protein that maintains the strength and elasticity of the skin.
The itching can be from mild to severe, with or without a rash or small bumps on the surface. The following home remedies may help to relieve itchiness during menopause:
- Use a cool wet compress to itchy areas can help to soothe irritation. Covering the area with a damp towel overnight may be particularly helpful if the itching disturbs sleep.
- Take a colloidal oatmeal bath but make sure it’s warm not hot.
- Moisturize regularly.
There are also over-the-counter and prescription medications such as steroid creams, anaesthetic creams, and antihistamines that can help stop the itch. Please seek advice from your pharmacist who can advise you on appropriate medications.
People can reduce the likelihood of itchy skin during menopause by doing the following:
- Avoid hot baths or showers. These can strip the skin of essential oils. Using lukewarm water is better for those with irritable skin.
- Pat yourself dry after bathing. Rubbing skin dry after a bath or shower can further irritate sore or itchy skin. Patting the skin lightly with a soft, clean towel should prevent further irritation.
- Avoid scratching. Although tempting, scratching the itch can tear and damage the skin, especially if it is already sensitive or inflamed. Instead, apply a cool compress to relieve itchiness. Wear gloves at night to stop itching in your sleep.
- Use scent-free skincare. Scented soaps and perfumes contain harsh chemicals that can further irritate the skin. Perfume-free soaps and cleansers marketed for those with ‘dry and sensitive skin’ are a safer option.
- Reduce alcohol and nicotine intake. These substances have a drying effect on the skin and can cause premature skin aging.
- Wear soft, loose fabrics. Cotton and loose-fitting clothes are less likely to irritate skin than wool or synthetic fibers that may also cling to the skin.
- Avoid strong sunlight. Harmful UV rays from the sun can further irritate dry, itchy, or sensitive skin. Use a high SPF sunblock suitable for sensitive skin.
- Stay hydrated. Water is essential for keeping the skin healthy and preventing dull, itchy skin.