Surviving breast cancer is a feat in and of itself. But the quality of life afterwards for many women has its own challenges.
A recent Australian study enrolled 843 women whom completed questionnaires at enrollment and every 12 months for 5 years (average follow-up was 6 years after diagnosis). Women were asked to self report any vasomotor, psychological, physical and sexual symptoms. Past chemotherapy or adjuvant endocrine therapy (ie. tamoxifen or aromatase inhibitors) had no independent effects on vasomotor and sexual scores.
Regardless of menopausal status, almost 80% of all women younger than 60 reported psychosocial and physical symptoms. Menopausal symptoms were most common and more severe in those aged 50-59. Also more than half of women aged 60-69 reported vasomotor and sexual symptoms as did more than one third of those over 70 years old. This study was compared with healthy community controls.
This study as well as other observational studies clearly show how women with breast cancer have significantly more severe menopausal symptoms, and that they are not adequately managed. The need for effective treatments in this ever growing population of breast cancer survivors is incredibly important. These women are struggling with quality of life issues. They go back to work exhausted due to hot flushes day and night that leads to chronic insomnia, anxiety, depression, pain with intercourse, and cognitive dysfunction (poor memory, concentration, focus, foggy-headed).
Current accepted non-hormonal treatments include anti-depressants (selective serotonin reuptake inhibitors) as a first choice. Sometimes these work quite well, but there are some limitations such as those on Tamoxifen should not use Paxil (paroxetine). Also, more than 50% of women develop hot flushes when taking chemo-preventative agents such as Tamoxifen or Aromatase inhibitors (Arimidex, Femara/Letrozole, Aromasin).
An anti-seizure medication, Neurontin (Gabapentin) has been shown to reduce hot flushes by 70%. Side effects can be fatigue and dizziness. Other medications include Megace (synthetic Progestin), Effexor (SNRI antidepressant), or Clonidine (alpha-2 agonist used to commonly treat high blood pressure). They may be effective, but all come with their own unique side effects.
I actually have used natural bio-identical estradiol tablets (Vagifem), ring Estring) or cream vaginally to help sexual symptoms such as low labido or pain with intercourse. Most of the oncologists in the area agree that these products (if used properly) are effective and safe for breast cancer survivors.
Accupuncture is also very effective in helping women’s symptoms.
I am also a big believer in magnesium. This important mineral is leached from our system and gets especially depleted from the adrenal glands when under chronic stress. Most breast cancer survivors are low in magnesium, primarily due to the fact that they have been under so much stress since their diagnosis. Besides oral magnesium, I recommend IV nutrients in the form of a Myer’s cocktail which includes B- vitamins, magnesium and Vitamin C. All of these nutrients infused intravenously help to reset and increase reserves of our adrenal glands to help women cope and adapt to their symptoms while eliminating many symptoms (even temporarily). Magnesium is a smooth muscle relaxant and calms the central nervous system so I find it really helps women finally sleep so much better and reduces anxiety and hot flushes.
In some cases I will use phyto-hormones, such as isoflavones (non-GMO), Maca, Black cohosh and even Estriol (weak estrogen). I do this followed by an estrogen metabolite test if these women were diagnosed with an estrogen receptor positive breast cancer. This test helps me determine if this women is at higher risk for cancer reoccurrence by using these modalities.
There are 3 large studies now underway: the HABITS study (opened in 1996), a second Swedish study (opened in 1998) and a british study (opened in 2000) each randomizing women on ERT/HRT (estrogen or hormone replacement therapy) or not for 2 years after a diagnosis of breast cancer. This will shed some light on whether hormones may be appropriate for some women and whether benefits would out weigh the risks for cancer reoccurrence. Most of these women will live a long time after their diagnosis and may more likely die of cardiovascular disease or osteoporosis vs breast cancer. We will anxiously be waiting for the results of these studies.
References: Davis SR et al. Menopausal symptoms in breast cancer survivors nearly 6 years after diagnosis. Menopause 2014 Oct; 21: 1075.
Carpenter JS and Milata JL. Do menopausal symtoms continue after oral endocrine therapy for breast cancer? Menopause 2014 Oct;21:1035.
Make sure to talk to your doctor or practitioner if you still have bothersome symptoms after being treated for breast cancer. There are options to help quality of life symptoms, yet hopefully we will see more down the pipeline soon.