Cancers that are hormone sensitive include most types of breast cancer, some ovarian cancers, endometrial cancer and one type of cervical cancer (adenocarcinoma of the cervix, not the more usual squamous cell carcinoma of the cervix).
Cancer treatment can put women into a temporary or permanent menopause. This may be by the removal of the ovaries, damage to the ovaries by chemotherapy or radiotherapy or by switching off the ovaries via oestrogen blocking drugs. In some younger women, the ovaries may start to function again and they then go through a natural menopause later on.
For most women with these cancers, systemic HRT (ie HRT that works throughout the body) is contraindicated. There are occasional exceptions to this but the individual risk v benefit ratio would need to be discussed with a menopause specialist and the oncology team. However local (vaginal) oestrogen can be used by most patients suffering from vaginal, vulval and urinary symptoms. Only patients on an aromatase – inhibitor are advised not to use local oestrogen. Vaginal moisturisers and lubricants can also be very helpful but it is important to choose products without any ingredients that irritate the vagina. I recommend the YES or Sylk products.
We do have non-hormonal options that can be prescribed in low doses to help with hot flushes and night sweats. These include venlafaxine, citalopram, gabapentin, pregabalin, oxybutynin and clonidine.
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
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 the book ‘Managing Hot Flushes and Night Sweats’ by Myra Hunter and Melanie Smith which is a self-help guide using CBT. Some areas now offer group CBT for these symptoms.
Lifestyle changes can also help with menopausal symptoms – see separate box.