First breast cancer and then menopause

Dear MHI reader

The double burden for affected women

Breast cancer is one of the most serious diagnoses a woman can receive. The physical and emotional strain during and after treatment is enormous. But many women face another challenge after treatment: premature and often more severe menopausal symptoms. Hot flushes, sleep disorders, dry mucous membranes or depressive moods are part of everyday life for many affected women.

Life seems to be out of balance – and these women often feel left alone. However, there are ways to specifically address the symptoms and significantly improve quality of life.

Why do women suffer more from menopause after breast cancer?

Breast cancer treatments, such as chemotherapy, tamoxifen or aromatase inhibitors, drastically reduce hormone levels. Stopping oestrogen production in the ovaries leads to an artificial menopause. This then leads to the typical menopausal symptoms, such as

• Severe hot flushes: Up to 50% of women report severe and persistent symptoms.
• Dry mucous membranes: This often leads to pain and discomfort, especially during sexual intercourse.
• Sweating: This can occur both during the day and at night.
• Psychological stress: Insomnia, depression and anxiety often overshadow the physical symptoms.

Even if treatment takes longer, this can have a negative impact on bone density. This increases the risk of osteoporosis. It would be advisable to check bone density regularly, preferably with a DXA scan.

Aromatase inhibitors stop oestrogen production in the muscles and fatty tissue, but not in the ovaries. This is why they are only recommended for women who are already postmenopausal, i.e. after the menopause. However, if the situation is particularly risky, an aromatase inhibitor can also be used in premenopausal patients. However, this must always be done together with a therapy that switches off the function of the ovaries. This can be done either with GnRH analogues (synthetic drugs that have a similar structure to the natural gonadotropin-releasing hormone (GnRH)) or by removing the ovaries. If only an aromatase inhibitor is administered, this can even lead to an increase in ovarian function.

Women who take tamoxifen or aromatase inhibitors are therefore particularly affected by menopausal symptoms. Unfortunately, these symptoms are often not taken seriously enough, as the priority is often to prevent cancer recurrence (a recurrence of cancer after a phase in which no tumour cells were detectable).

Hormone replacement therapy: not an option for many women

After breast cancer, hormone preparations are often considered contraindicated (must not be used) as they could increase the risk of cancer recurrence. However, research shows that there are alternatives to treat menopausal symptoms safely and effectively.

What really helps: a personalised approach

1. non-hormonal treatments for hot flushes

Fezolinetant (Veoza) is a new drug that does not require hormones and has been developed specifically for the treatment of hot flushes. It blocks a protein in the brain that is responsible for regulating body temperature. Alternatively, phytoestrogens can also be taken.

Tip: Discuss this with your gynaecologist.

2. alleviate vaginal dryness

Moisturising creams or gels are often the first choice for dry vagina. In certain cases, low-dose local oestrogens can be considered, provided you receive comprehensive advice and information.

Newer option: Laser therapy has been shown to be an effective, hormone-free method of relieving vaginal discomfort, particularly during the menopause.

3. reduce sweating

Regular exercise and sport improve sweating. Women who keep fit are rewarded by their bodies with ‘happiness hormones’ (endorphins), which in turn leads to greater inner satisfaction and balance.

Tip: Combine this with strength training. This will cause your body to burn more energy again and keep your figure in shape.

4 Holistic approaches for a better quality of life

In addition to medical therapy, relaxation methods such as yoga, meditation and hypnosis play an important role. Stress management and a healthy diet can also help to reduce symptoms and increase well-being.

5 Strengthen bone density and prevent osteoporosis

Regularly checking your bone density is essential. Optimise your calcium and vitamin D intake.

Tip: Combine this with regular exercise such as strength training or yoga to promote bone health and alleviate depressive moods.

Help is possible – and it’s worth getting active

Women struggling with menopausal symptoms after breast cancer face unique challenges. However, with personalised and holistic care, many of these symptoms can be effectively alleviated. It is important that those affected take their symptoms seriously and seek support at an early stage – be it from doctors, specialised advice centres or self-help groups.

You are not alone – and there are many ways to master this phase of your life with strength and more joie de vivre!