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Home > Understanding Breast Cancer > After Treatment > Life Issues > Treating Menopausal Symptoms

  


Treating Menopausal Symptoms

 

Menopausal hormone therapies (oral versus vaginal therapies)

There are different types of menopausal hormone therapy (MHT) used to relieve menopausal symptoms (such as hot flashes). Some are taken orally (in pill form), some are used vaginally and others are used in a patch form (similar to a nicotine patch).  

Oral MHT is approved by the U.S. Food and Drug Administration (FDA) for the short-term relief of menopausal symptoms. However, the use of oral MHT increases the risk of breast cancer [103-105,158]. The FDA recommends women use only the lowest dose that eases symptoms for the shortest time needed [106]. Because oral MHT may also increase the risk of breast cancer recurrence, it is usually not given to breast cancer survivors [110].  

Vaginal hormone therapies do not appear to increase the risk of breast cancer (learn more) [154-155].  

Whether hormone patches affect breast cancer risk is still under study.  

Some common menopausal symptoms and treatment options are discussed below. Some options contain hormones and others do not. Talk to your health care provider about the best methods for you.

Komen Perspectives 

Read our perspective on managing menopausal symptoms (April 2012).*  

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 vaginal dryness. Some methods contain hormones and some do not. Talk to your health care provider about which option is best for you.

Vaginal therapies that contain hormones

Hormonal options for the relief of vaginal symptoms include an estrogen-containing soft ring (put into the vagina like a diaphragm), vaginal estrogen suppositories and vaginal estrogen cream. These products may slightly increase blood estrogen levels, but for only a short time and most physicians believe they are safe for breast cancer survivors [154-155]. These products require a prescription.

Vaginal therapies that do not contain hormones

A non-hormonal option for vaginal symptoms is an estrogen-free vaginal moisturizer (such as Replens). These products are different from vaginal lubricants (such as K-Y Jelly and Astroglide) which only make surfaces slippery, rather than moisturizing. For the best effect, moisturizers need to be used regularly (several times a week), rather than just around the time of intercourse. Because they do not contain estrogen, they're safe for breast cancer survivors. Vaginal moisturizers are available over the counter (without a prescription).

Talk to your provider about the benefits and risks for each of these options.

Oral medications that have hormonal effects

In February 2013, the FDA approved the drug ospemifene (Osphena) for postmenopausal women who experience pain during intercourse due to vaginal dryness [168]. Ospemifene can reverse some of the physical changes that occur in vaginal tissues during menopause. This can ease pain during intercourse [168]. Ospemifene is a pill (taken by mouth) and requires a prescription. Because ospemifene has some hormonal effects, it is currently not recommended for breast cancer survivors.  

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. (Learn more about early menopause.) 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 survivors.  

Medications

A number of medications have been studied for the treatment of hot flashes and other menopausal symptoms. Figure 6.2 below provides a summary of some of these medications.  

SSRI and non-SSRI antidepressants 

Among the most promising medications for treating hot flashes is a group of antidepressants called selective serotonin reuptake inhibitors (SSRIs). SSRIs include citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil) and sertraline (Zoloft). These drugs, and the non-SSRI antidepressants venlafaxine (Effexor) and desvenlafaxine (Pristiq), have been shown to decrease the frequency and strength of hot flashes by 50 to 60 percent, with few side effects [114-121]. In June 2013, the SSRI paroxetine (Brisdelle) was FDA-approved for treating hot flashes [169].  

Some SSRIs (including paroxetine) can interfere with tamoxifen [122-123]. If you are taking tamoxifen, talk to your health care provider before taking an SSRI.  

Gabapentin 

A few studies have shown gabapentin (Neurontin), a drug used to treat seizures and pain, can reduce hot flashes, to varying degrees [124-127].  

Megestrol acetate

At high doses, the drug megestrol acetate is used to treat metastatic breast cancer. In low doses, it may reduce hot flashes in breast cancer survivors [128-129]. 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 blood clots or weight gain.

  

For a summary of research studies on antidepressants and other non-hormone medications for menopausal symptoms, visit the Breast Cancer Research section

 

Vitamin E and plant-based remedies

To date, there is little evidence that vitamins and plant-based remedies can reduce hot flashes in breast cancer survivors. Figure 6.2 below gives a summary of some vitamin and plant-based remedies.

Vitamin E

Although one small randomized controlled trial found that vitamin E slightly reduced hot flashes, most studies have not shown this benefit [126,130].

Learn more about vitamin E.

Soy and black cohosh

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 [131-135]. Although these studies did not show any harmful side effects of soy or black cohosh for breast cancer survivors, there are no long-term safety data.

Learn more about soy and black cohosh.

Learn more about soy and breast cancer risk

   For a summary of research studies on soy for menopausal symptoms, visit the Breast Cancer Research section.
   For a summary of research studies on black cohosh for menopausal symptoms, visit the Breast Cancer Research section.  
  For a summary of research studies on other supplements for menopausal symptoms, visit the Breast Cancer Research section.  

 

Figure 6.2: Non-hormonal therapies used to treat common menopausal symptoms

 

Summary of Evidence from Randomized Controlled Trials

Short-term Health Risks

Long-term Health Risks

Medications
(It is important to talk to your health care provider before taking any of these medications.) 

Clonidine

Some evidence of reduced frequency of hot flashes among breast cancer survivors.

Sleeping problems, low blood pressure, constipation and dry mouth.

Unknown.

DHEA
 

No benefit over placebo for hot flashes.

Unknown.          
 

Unknown.
 

Gabapentin (Neurontin)

Some evidence of reduced strength and frequency of hot flashes and relief of sleeping problems.

Dizziness, drowsiness and swelling in arms and legs.
 

Unknown.

Ospemifene (Osphena)

Strong evidence of improved vaginal symptoms (and thus, reduced pain during intercourse).

Hot flashes, vaginal discharge, muscle spasms and excessive sweating.

In rare cases, stroke, endometrial cancer and deep vein thrombosis.

Should not be used long-term.

Unknown.

SSRI antidepressants

Strong 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 if stopped too quickly.

Unknown.

Venlafaxine

Strong 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 if stopped too quickly.

Unknown.

Zolpidem (Ambien)
 

Some evidence of relief of sleeping problems.
 

Headache, respiratory infection, drowsiness and dizziness. 

Cannot be used long-term. 

Unknown.
 

Vegetable or plant-based remedies
(It is important to talk to your health care provider before taking any of these products.)  

Black cohosh

No benefit over placebo for hot flashes.

Nausea, headache, dizziness and in rare cases, liver damage.

Unknown.

Dong quai root

No benefit over placebo for hot flashes.

Can interact with warfarin and lead to bleeding problems.

Unknown.

Evening primrose oil

No benefit over placebo for hot flashes.

Mild nausea, diarrhea and bloating.

May worsen some types of epilepsy.

Unknown.

Flaxseed

No benefit over placebo for hot flashes.

None.

Unknown.

Ginseng root

Some evidence of relief of vaginal dryness and sleeping problems.

None.

Unknown.

Red clover extract

No benefit over placebo for hot flashes.

None.

Unknown.

Soy

Most studies report no benefit over placebo for hot flashes or vaginal symptoms.

Breast cancer survivors should discuss taking high doses of soy with their health care provider.

Unknown.

Vitamin E

Some evidence of a small decrease in frequency of hot flashes among breast cancer survivors.

None.

Unknown.

Adapted from National Institutes of Health, North American Menopause Society and selected studies [136-142].

 

Acupuncture

A few, small randomized controlled trials have studied whether acupuncture may offer relief from hot flashes in breast cancer survivors. Studies comparing the benefit of true acupuncture to sham acupuncture have found mixed results. Some findings showed acupuncture reduced hot flashes more than the sham treatment, while others found no difference between the two [143-145].  

At this time, data are too limited to draw conclusions on the benefit of acupuncture for the relief of hot flashes in breast cancer survivors. This topic is still under study.  

Learn more about acupuncture.

 

   For a summary of research studies on acupuncture for menopausal symptoms, visit the Breast Cancer Research section.

 

 

Cognitive behavioral therapy

Cognitive behavioral therapy is a special type of mental health counseling. Group sessions are led by a mental health provider (such a psychologist or social worker) and may include techniques such as relaxation exercises.  

A few, small randomized controlled trials have studied whether cognitive behavioral therapy can ease menopausal symptoms in breast cancer survivors. Some findings have shown it may decrease hot flashes for breast cancer survivors [157,170].  

One study looked at a measure of sexual activity that included 10 items such as enjoyment of and satisfaction with sexual activity, desire for sex, pain or discomfort during sex and frequency of (and satisfaction with frequency of) sexual activity [171]. Women who got cognitive behavioral therapy plus exercise had higher scores on this measure of sexual activity than women who did not get cognitive behavioral therapy or exercise [157].  

At this time, few people are trained to give cognitive behavioral therapy and it is not widely available. 

Tips for managing hot flashes

Although studies are limited at this time, the following tips may help relieve hot flashes [159]. 

 

 Tips for relieving hot flashes [159]

  • Quit smoking (if you smoke)

  • Reduce alcohol use (if you drink)  

  • Dress in layers  

  • Keep an ice pack under your bed pillow

  • Avoid caffeine and hot drinks

  • Avoid hot or spicy foods

  • Keep your home or bedroom cool
 

 


Bio-identical hormones

There is no medical or scientific definition for the term “bio-identical hormones”, so you may hear this term used in different ways. Some people use it to describe hormone drugs that have the same chemical and molecular structure as hormones found in the body. (Not all products that claim to be bio-identical meet this definition.)

Compounded bio-identical hormones

“Bio-identical" may also refer to hormone therapies that are custom compounded (when a pharmacist makes a mixture of hormones according to the physician’s instructions on a prescription) [111-113]. It is important to remember:

  • Compounded bio-identical hormones have not been shown to be safer than FDA-approved oral MHT. There is no evidence compounded bio-identical hormones have fewer health risks than FDA-approved MHT. And, because they have not been well-studied, compounded bio-identical hormones may have more health risks [111-112].
  • Compounded bio-identical hormones have not been shown to be more effective at treating menopausal symptoms than FDA-approved MHT [111-112].
  • Compounded bio-identical hormones are not more “natural” than FDA-approved MHT [111-112].
  • There is no scientific evidence that saliva tests to check hormone levels are useful in making custom compounded hormone therapies [111-112].

To learn more about bio-identical hormone therapies, visit the FDA website.    

*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time. 

Updated 08/26/13

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