Hormone Therapy (HT) or Hormone Replacement Therapy (HRT)
If the cancer is not hormone related your doctor can usually prescribe HRT (hormone replacement treatment) to improve menopause symptoms and protect your heart and bones. However, HRT is not generally recommended for women with breast cancer, and if you are already taking HRT when diagnosed you may be advised to stop.
There are 2 types of HT; Estrogen Progestin Therapy (EPT) or Estrogen Therapy (ET)
- EPT – is combined estrogen plus progestogen therapy. After menopause, women don’t naturally produce estrogen, so in order to relieve many of the symptoms associated with the menopause, such as hot flushes and mood swings, and to reduce the risk of osteoporosis, progestogen is added to ET to protect women against the increased risk of uterine (endometrial) cancer.
- ET - is estrogen therapy, without progesterone. ET is often prescribed to women without a uterus following a hysterectomy.
HRT can be prescribed in a number of ways:
- Tablets are the most common way of taking HRT –many women find this the simplest way of having treatment. However, it's important to be aware that some of the risks of HRT, such as blood clots, are higher with tablets than with other forms of HRT (although the overall risk is still small).
- Skin patches are also common. You stick them to your skin and replace them every few days. Using patches can also help avoid some side effects of HRT, such as indigestion, and unlike tablets they don't increase your risk of blood clots.
- Estrogen gel is an increasingly popular form of HRT, but if you still have your womb, you'll need to take some form of progestogen separately too, to reduce your risk of womb cancer.
- Vaginal estrogen helps to relieve vaginal dryness although it won’t help with hot flushes. It’s available as a cream, pessary or ring that is placed inside your vagina.
It is important to discuss all the pros and risk factors with your doctor and do your own research before deciding what to take. You will also need to be monitored and have follow-up checks.
Other prescribed medications
HRT isn’t your only option. If HRT isn’t right for you ask your doctor about other prescribed medications that may also help improve your symptoms.
- Antidepressants (SSRI and SNRI) - Certain antidepressant medications are prescribed to treat hot flashes and other symptoms
- Clonidine - a blood pressure medication, it causes your blood vessels to dilate. This may help to reduce hot flashes and night sweats
- Gabapentin (Neurontin) - A drug often prescribed for pain relief and seizures, which has also been reported as helping to reduce hot flashes
- Tibolene - A synthetic molecule used extensively for the management of menopausal symptoms, with the proposed additional advantage of enhanced mood and libido
- Bioidential hormones – These are made in a lab from chemicals found in plants but are supposed to be more like the hormones your body naturally produces than those used in HRT. It’s still early days of development and has not yet been rigorously tested on humans, so long-term health risks are not yet known
- Vitamins & minerals – Ask your doctor for a test to see whether you are deficient in any vitamins or minerals that your body may need or be lacking in and may be making you feel worse. Your doctor may be able to prescribe supplements or advise on over-the counter products and dosages
Vitamins & minerals
If you have a healthy, well-balanced diet you should be giving your body all the nutrients it needs to stay topped up with good vitamins and minerals. However, this isn’t always the case as menopause can cause depletion of some vitamins and minerals even with a healthy diet. Some people are pre-disposed to a lack of certain vitamins and minerals due through their ethnicity and genes and if you are unwell or undergoing treatment and your appetite isn’t what it should be then you may need to take supplements. Work with a doctor or other healthcare provider to make a treatment plan. They can help you assess your individual needs and risk level as well as advise you on dosage
- Vitamin C – Can help to keep ligaments and tendons strong, resulting in reduced pain from aching joints. It also strengthens and keeps blood vessels healthy and helps to maintain good circulation. Also known to help skin and immune system
- Vitamin E - An antioxidant that helps fight cell-damaging free radicals in the body. Research has shown vitamin E helps ease stress, reduces oxidative stress, and may help reduce your risk of depression during menopause as well as helping your skin.
- Vitamin B-6 (pyridoxine) – This vitamin helps make serotonin, a chemical responsible for transmitting brain signals. As women age, serotonin levels drop and may be a contributing factor in the mood swings and depression common in menopause. Taking a vitamin B-6 supplement during and after menopause may help tame and prevent symptoms such as loss of energy and depression.
- Vitamin B - Includes thiamine, niacin, B12 and folic acid, and are often referred to as the ‘stress’ vitamins. They help to relieve tension and irritability, help you managing stress, increase concentration, and reduce anxiety.
- Vitamin D - Reduces your risk of bone fractures and reduces bone pain and osteomalacia (softening of the bones), and therefore vital to help bone density during and after menopause.
- Magnesium – This is a bit of a wonder mineral for all-round wellbeing during and post menopause. It supports the production of brain chemicals that control mood, alongside healthy blood pressure, glucose control, energy metabolism, bone health as well as maintaining a healthy nervous system. It’s also essential for the absorption and metabolism not only of vitamin D but of calcium as well. Magnesium helps with menopausal insomnia and other symptoms such as low mood so making sure you’re topped up is crucial
- Calcium – prevents depletion of bone mass and reduces the risk of osteoporosis. Because of the decrease in estrogen production after menopause, women are less able to retain calcium from dietary sources
- Omega 3 - Omega 3 fish oil contains large amounts of essential fatty acids DHA and EPA, which can help build brain cells as well as regulate levels of serotonin to smooth out mood swings associated with menopause
Herbal and plant extracts are known to have been used for many 100s years to help relieve symptoms – although research may not have proven herbal supplements to be effective some people swear by them. As with all therapies, there are some risks involved. Keep in mind that herbal supplements are not as closely regulated as prescription drugs and the amount of herbal product, quality, safety, and purity may vary between brands or even between batches of the same brand. Herbal therapies may also interact with prescription drugs, resulting in dramatic changes in the effect of the botanical, the drug, or both. To be safe, do your research and tell your healthcare medical team about all botanical therapies you are considering and always stop all herbal treatments at least 2 weeks before any planned surgery.
- Angelica (Dong Quai) - Relief for hot flushes, hormone headaches, mood swings and cramping
- Vitex agnus-castus (also called chaste- berry) – Relief for hot flushes
- Black Cohosh - Relief for hot flushes. Not to be used if you have liver problems
- Evening primrose – Relief of hot flushes and other symptoms. It should only be taken under guidance from a medical professional because of reported side effects
- Flaxseed and flaxseed oil - A good source of lignans, which can help to balance female hormones and ease hot flushes and night sweats
- Ginseng - May help with mood symptoms and sleep disturbances, and with one's overall sense of well-being
- Kava - May decrease anxiety - although the FDA has issued a warning to patients and providers about kava because of its potential to damage the liver
- Maca - Rich in a number of nutrients, including vitamin C, copper and iron. Helps to reduce their hot flushes and gives them a better nights’ sleep
- Milk Thistle - shown to regenerate liver cells and can help ensure optimal liver function. Helps menopausal hormonal balance, calming, balancing mood and promoting sleep.
- Red Clover - Natural plant estrogens help to ease menopause symptoms. So far, though, the research results have been mixed
- Sage Leaf - Traditionally used for a range of conditions, including menopause symptoms such as hot flushes and night sweats
- Starflower (also known as Borage oil) - Several health benefits, including heart function, skin appearance and vision
- St John’s Wort - Reduces hot flushes and night sweats during menopause. However, it can interfere with other drugs, including those used to treat breast cancer (for example, tamoxifen)
- Valerian – May help to calm neurotransmitters that stabilize mood and boosts relaxation and sleep. Can also help reduce stress and lower blood pressure and heart rate. Best taken at night
- Licorice - May help keep your adrenal system from becoming fatigued. Some research also suggests that licorice supplements can decrease hot flushes and night sweats
- Menopause mixes – You can buy mixes containing different natural remedies in single tablet form …do your research and check out the ones that are specially formulated for menopause
Foods & Fluids – healthy eating
Drink water – keeping hydrated is very important in general. if you are having a flush, you’re probably sweating so drinks lots of water to replenish your stores and help regulate your internal temperature
Make sure you have a healthy balanced diet and if lacking in any key vitamins and minerals try to increase your consumption of foods containing the relevant sources
Exercise as we know helps to keep you fit and healthy and is especially beneficial during menopause. Studies have shown that exercise on a regular basis can make bones and muscles stronger and help prevent bone loss. Weight-bearing exercises such as jogging, playing tennis, and dancing three to four times a week are best.
Also Try out Yoga and Tai Chi to help with flexibility and mindfulness practices. If you can’t manage weight bearing exercise because you’re not feeling up to it try other exercise such as swimming or, walking – it’s important to try to do whatever you feel you can manage.
According to a new study by North American Menopause Society (NAMS), mindfulness practices, such as meditation, deep breathing and staying focused in the present, may help ease menopause symptoms like hot flashes and the stress that can accompany menopause
Acupuncture can also be an effective way to deal with the symptoms of menopause. It has been shown to help menopausal symptoms, by balancing hormones, reducing hot flushes, insomnia and irritability and by inducing better sleep.
Cognitive behaviour therapy (CBT)
Cognitive behaviour therapy is a proven approach that can be helpful for a range of menopausal health problems, including anxiety and stress, depressed mood, hot flushes and night sweats, sleep problems and fatigue
Other ways to help control symptoms
- Dress in layers and layer down when you’re having a flash
- Keep a hand-held fan about you to use
- Use a cool pad or pillow at night or fan
- Could try clothing – fabrics specially for sweating
- Breathe slowly and deeply - controlled breathing just as you start a hot flash can shorten and lessen it
- Avoid hot and spicy foods, alcohol, caffeine and smoking - they may trigger a flashTry and get at least 20 minutes of sunshine a day
- Maintain a regular bedtime schedule, including going to bed at the same time every night and keep your bedroom cool
- Take time to relax every day
- Have a massage to help aches and pains and help relax
- Keep working on your pelvic floor exercises
Next week in our third instalment we will be covering fertility and cancer treatment.
What other tips and advice do you have? Join the Chemotherapy Support Group and share your tips or ask advice from thousands of members.