Women can get many of the benefits of postmenopausal hormones through other means. For example, instead of taking postmenopausal hormones to help prevent osteoporosis and heart disease, women can get regular exercise and eat a healthy diet [69]. There are also other treatments for the relief of menopausal symptoms such as vaginal dryness and hot flashes.
Vaginal Symptoms
One of the most common symptoms of menopause is vaginal dryness, which can cause pain during intercourse, vaginal soreness and itching. Breast cancer survivors have several options for the relief of these symptoms, including estrogen-free vaginal moisturizers (such as Replens and Astroglide) that are similar to natural vaginal lubricants. Because they do not contain estrogen, they're safe for women with breast cancer and are available over the counter without a prescription.
Other options for vaginal symptoms are an estrogen-containing soft ring that is put into the vagina like a diaphragm, or a vaginal estrogen suppository. These products slightly increase the level of estrogen in the blood but for only a short time, and most breast oncologists believe they are safe. A woman should talk with her health care provider about the benefits and risks for each of these options.
Hot Flashes
Breast cancer survivors may have hot flashes if they go through early menopause due to chemotherapy. These women may have worse symptoms than those who go through menopause at later ages (for more on early menopause, visit the Side Effects of Chemotherapy section). Hot flashes can also be a side effect of hormone therapy. Some medications, vitamin E and plant-based remedies have been studied for the relief of hot flashes in breast cancer survivor
Medications
SSRI and non-SSRI antidepressants
A number of medications have been studied for the treatment of hot flashes. Among the most promising is a group of antidepressants called selective serotonin reuptake inhibitors (SSRIs). SSRIs include citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil) and sertraline (Zoloft). These drugs, and a non-SSRI antidepressant called venlafaxine (Effexor), have been shown to decrease the frequency and strength of hot flashes by 50 to 60 percent, with few side effects [70-75].
Because some SSRIs can interfere with tamoxifen, if you are taking tamoxifen you should speak to your health care provider before taking these medications. Figure 6.2 below provides a summary of these non-hormone therapies for menopausal symptoms.
Gabapentin
A few studies have found that gabapentin (Neurontin), a drug used to treat seizures and pain, is effective in reducing hot flashes, to varying degrees [76,77].
Megestrol acetate
The drug megestrol acetate is used at high doses to treat metastatic breast cancer. In low doses, it has also been shown to reduce hot flashes in breast cancer survivors [78,79]. However, the safety of lower dose megestrol acetate in women with early breast cancer has not been proven. At higher doses, this drug can cause side effects, such as weight gain or blood clots.
Vitamin E and Plant-based Remedies
There is little evidence that vitamins and plant-based remedies studied to date reduce hot flashes in breast cancer survivors. One small randomized controlled trial found a slight benefit of vitamin E on hot flashes [80].
In randomized controlled trials, breast cancer survivors who took soy or black cohosh were no less likely to have hot flashes than those who took a placebo [81-86]. Although these treatments did not have any harmful effects in these trials, there are no long-term safety data for breast cancer survivors. Soy is a concern because it contains plant estrogens that have not been proven safe in breast cancer survivors. Figure 6.2 below gives a summary of these vitamin and plant-based remedies.
For more on vitamin E, see the Complementary Therapies section.
For more on black cohosh, see the Complementary Therapies section.
For more on soy, see the Complementary Therapies section.
For more on soy and breast cancer prevention, see the Risk Factors and Prevention section.
Figure 6.2: Non-hormonal therapies used to treat common menopausal symptoms
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Summary of Evidence from Available Randomized Controlled Trials
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Short-term Health Risks
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Long -term Health Risks
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Medications (It is important to talk to your health care provider before taking any of these medications.)
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| Clonidine |
Studies have shown mixed results. Some evidence of reduced frequency of hot flashes among breast cancer survivors. |
Sleeping problems, constipation and dry mouth. |
Unknown. |
DHEA
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No benefit over placebo for hot flashes. |
Unknown.
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Unknown.
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| Gabapentin (Neurontin) |
Some evidence of reduced strength and frequency of hot flashes and relief of sleeping problems. |
Dizziness, drowsiness, rash and swelling in arms and/or legs.
|
Unknown. |
| SSRI antidepressants |
Evidence of reduced strength and frequency of hot flashes. |
Dry mouth, constipation, reduced sexual desire, sleeping problems, headache and nausea. May interact with tamoxifen. May have withdrawal symptoms. |
Unknown. |
| Venlafaxine |
Evidence of reduced strength and frequency of hot flashes. Some evidence of increase in sexual desire. |
Dry mouth, constipation and nausea. May have withdrawal symptoms.
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Unknown. |
Zolpidem (Ambien)
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Some evidence of relief of sleeping problems.
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Headache, respiratory infection, drowsiness and dizziness.
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Unknown.
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Vegetable or Plant-based Remedies (It is important to talk to your health care provider before taking any of these medications.)
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Black cohosh
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No benefit over placebo for hot flashes.
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Nausea, headache, dizziness and in rare cases, liver damage.
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Unknown.
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Dong quai root
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No benefit over placebo for hot flashes.
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Can interact with warfarin and lead to bleeding complications.
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Unknown.
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Evening primrose oil
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No benefit over placebo for hot flashes.
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Mild nausea, diarrhea and bloating. May worsen some types of epilepsy.
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Unknown.
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Flaxseed
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No benefit over placebo for hot flashes.
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None.
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Unknown.
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Ginseng root
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Some evidence that relieves vaginal dryness and sleeping difficulties.
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Side effects similar to placebo.
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Unknown.
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Red clover extract
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No benefit over placebo for hot flashes.
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Side effects similar to placebo.
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Unknown.
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Soy
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Studies have shown mixed results, but most report no benefit over placebo for hot flashes or vaginal symptoms.
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Breast cancer survivors should discuss taking high doses of soy with their health care provider.
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Unknown.
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Vitamin E
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Some evidence of a small decrease in frequency of hot flashes among breast cancer survivors.
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None.
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Unknown.
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Adapted from National Institutes of Health, North American Menopause Society and selected studies [87-93].
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Updated 09/12/09
