Cancers that are hormone-sensitive include most types of breast cancer, endometrial cancer and some types of ovarian cancer. There are other cancers that can be hormone sensitive too eg some meningiomas, lung, gastric and bladder cancer.
Treatment for many different cancers, not just the hormone-sensitive ones, can put women into a temporary or permanent menopause. This may be by the removal of the ovaries, switching off the ovaries via medication, damage to the ovaries by chemotherapy or radiotherapy or by taking drugs such as tamoxifen or aromatase inhibitors. In some younger women, the ovaries may start to function again (unless they have been removed) and women then go through the natural menopause later on.
For most women with a hormone-sensitive cancer, systemic HRT (ie HRT that works throughout the body) is contraindicated. There are occasional exceptions to this if all other possible options have been tried and the symptoms are unbearable. In these cases the individual risk versus benefit ratio would need to be discussed with the patient, her menopause specialist and her oncology team.
Local (vaginal) oestrogen can be used by most of these patients who are suffering from vaginal, vulval and urinary symptoms. Women on an aromatase – inhibitor are usually advised not to use local oestrogen but this can be discussed with the oncology team. Vaginal moisturisers and lubricants can also be very helpful but it is important to choose products without any ingredients that can irritate the vagina. Menopause specialists often recommend the YES products (yesyesyes.org) and these can be prescribed via NHS prescription for those with a cancer diagnosis.
We do have non-hormonal options that can be prescribed in low doses to help with hot flushes, night sweats and some of the other symptoms. These include venlafaxine, escitalopram, gabapentin, pregabalin, oxybutynin and clonidine. There is a new medication called fezolinetant (Veozah) that NICE will be assessing in mid-2024.
These options can be discussed with your GP or menopause specialist.
Cognitive behavioural therapy has been shown to help with hot flushes and night sweats as well as the sleep issues caused by the menopause. I recommend a book called ‘Living Well through the Menopause’ by Myra Hunter and Melanie Smith. This is an evidence-based self-help guide using a cognitive behavioural therapy approach. Some areas now offer group CBT for these symptoms.
Lifestyle changes can also help with menopausal symptoms – see separate box.
Tips for managing hot flushes and night sweats:
- avoid triggers such as alcohol, caffeine, spicy foods and smoking
- drink cool rather than hot fluids and keep well-hydrated
- wear cool, loose fitting layers of clothing
- avoid sudden changes of temperature eg. hot baths or hot rooms
- you can use fans, clothing designed to absorb moisture, cooling bedlinen and other items such as pillows
- consider a separate, lower tog duvet just for you
- keep the bedroom cool with an open window if possible
- allow plenty of time for tasks to avoid extra stress
