1. The document discusses menopausal symptoms that can occur in younger women undergoing breast cancer treatment, such as hot flashes, vaginal dryness, mood changes, and sleep disturbances. 2. Potential coping strategies are presented, including lifestyle changes, relaxation techniques, prescription medications, and exercise. 3. It is recommended that women discuss any menopausal symptoms or medications with their medical oncologist.

1. Supporting People with Breast Cancer 2012
Managing Menopausal Symptoms in Younger
Women
Emily O’Donovan – Clinical Nurse Specialist
Breast Care

2. Welcome
• Brief Introduction
•Short presentation; including menopausal
symptoms and possible coping mechanisms
•Group discussion and experiences

3. Menopause
• Natural and inevitable event in all women's lives
• Menstruation stops and the ovaries cease
production of oestrogen and progesterone
• Average age of menopause in Ireland is 50 years
• Many women go through menopause gradually
and are ‘perimenopausal’ over many months
• Other factors can induce early or premature
menopause Women’s Health Council 2008 (www.dohc.ie)

4. Factors influencing Menopause during
Cancer Treatment
• Chemotherapy
• Ovarian Ablation
• Hormone Therapy
• Radiotherapy
• Surgery
These treatments can make cause menopausal
symptoms to start quite suddenly

5. Symptoms
• Menstruation ceases (permanent or temporary)
• Hot flushes /Night sweats
• Vaginal dryness
• Reduced libido
• Mood changes
• Changes to skin and hair
• Anxiety
• Sleep disturbance, strange dreams, insomnia
• Difficulty with concentration and memory
• Joint aches and pains

6. Hot Flushes
• This is the most common menopausal symptom
associated with breast cancer treatment
• Vary in frequency and intensity, some women
have associated palpitations
• Cause night sweats- which can be disruptive to
sleep
• Flushes have triggers such as hot showers, spicy
food, anxiety or upset
• The intensity of flushes may decrease in time

7. What may help…
• Wear layers of clothes, especially when out and
about (natural silk or cotton fibres help)
• Use layers of bedclothes an keep a spare pillow
nearby
• Drinking cool water
• Use a cooling spray or moist wipes
• Small or desk fans
• Cooling pads under prosthesis or BodiCool
prosthesis

8. What may help…
• Wearing scarves instead of hairpieces or partial
hairpieces with hats
• Keep a diary or note of triggers and try to avoid
these when possible
• Exercise – this produces natural endorphins and is
often a good way to get some fresh air
• If taking Tamoxifen (20mg) try taking half in
morning and half in evening.

9. Vaginal Dryness
• This is caused by low levels of oestrogen
• It can cause pain and irritation
• Dryness can contribute to already reduced libido
• Distress caused by vaginal dryness can be hard to
discuss; even with a partner or health care
professional.

10. What may help…
• Vaginal lubricants can be water based (KY, Astroglide) or
oil based (such as Yes or baby oil). Oil based can be longer
acting
• Vaginal moisturisers (Replense or Senselle) are available
in pharmacies and can last a few days
• If you can get past the problem of the dryness,
intercourse can help blood flow to the area and improve
elasticity
• Always rule out any infection if symptoms change
• Discuss oestrogen pessaries or creams with you medical
oncologist

11. Reduced Libido
• When women are diagnosed with cancer they may loose
interested in sex for many reasons; both physical and
emotional
• Menopausal symptoms
• Pain, > 60% of women experience pain during sex after
breast cancer treatment
• Change in body image, self esteem and confidence
• Fatigue
• Meeting a new partner

12. What may help…
• There is no right time to talk to a partner about
this, no matter how long you have known each
other
• Re-familiarise yourself with your body
• Try to talk to your partner about any fears you
may have
• Look at it as part of your recovery, try to think and
talk about it like you did treatment

13. Mood Changes
• Brain function can be affected by oestrogen levels
• This can result in poor concentration or forgetfulness
• Moods can fluctuate from high to low and vice versa, very
quickly
• Try to see if there are any stressful triggers you can
identify
• Think of activities which help you relax or improve your
mood
• Exercise can help release endorphins (‘happy hormones’)

14. Sleep Disturbance
• Sleep can be disturbed by physical changes in the
body like hot flushes and emotional causes too
• Many women experience strange dreams or
nightmares
• Insomnia is a common menopausal symptom and
many women report loneliness at this time
• Try to spend time relaxing before bed
• Have a change of clothes/ pillow near by

15. Joint Pain
• Joint pain can be caused by lower levels of
oestrogen
• It can occur when you are given Zoladex
• It is more commonly associated with older women
who are taking aromatase inhibitor rather that
younger women taking Tamoxifen
• Talk to your medical oncologist if you are
concerned about osteoporosis

16. Relaxation
• Many women find that reducing stress may help
symptoms less severe
• Relaxation, whether it is on your own or with the help of
a CD/DVD may help
• Professionals are available to help with dealing with
anxiety –many patients fine Cognitive Behavioural
Therapy (CBT) helpful (ARC or psycho-oncology services
• Simple things such as lavender and a quiet room can help
• Allowing your time to relax is important – again, look at it
as an important part of your recovery

17. Complementary Therapies
• Relaxation
• Reflexology
• Aromatherapy
• Massage
• Meditation
• There is little evidence about the use of
complementary therapies and you should always
talk to your medical oncologist and therapist
before commencing treatment

18. Non-prescription Medications
• Many women find evening primrose oil helpful in
reducing menopausal symptoms
• Interesting Vitamin E and Black cohosh are not
recommended in the UK due to conflicting
evidence in research; it is not discouraged in
Ireland
• Phyto-oestrogens are naturally occurring in many
plant products (linseed and soya) and again
evidence supporting its use can be conflicting

19. Prescription drug therapies
• Anti- depressant drugs have been found to reduce the
severity of hot flushes for some women (e.g. Effexor). It is
a lower dose than when it is given as an anti-depressant
so it is unlikely to effect mood or libido directly.
• Some anti-epileptic medications (e.g. Gabapentin) can be
prescribed to help regulate sleep
• Medications used to reduce blood pressure (e.g.
Clonadine) can also reduce hot flushes
• Low dose HRT can be considered
• Any medication should be discussed with your medical
oncologist

20. Exercise
• Current research suggests that exercise can help
prevent recurrence
• It is widely known to increase endorphins
• It can be free – taking time out for a walk
• Pilates or Yoga can also help to relax
• Setting yourself a challenge can boost your self
esteem
• Exercise with other people can be a good form of
support