Revised November 2001

Menopause symptoms for:

Woman who has had breast cancer
Woman who has never had breast cancer

Woman who has had breast cancer

The BC Cancer Agency Breast Tumour group does not recommend menopausal hormonal therapy to alleviate menopausal symptoms for women who have had breast cancer. Patient experience suggests that management of menopausal symptoms are minimized as follows:

Symptoms or Concerns	Possible Non-Hormone Treatment
Hot Flushes	- Avoid triggers. These can be alcohol, caffeine (from coffee, tea, cola) chocolate, stress, hot weather. - An  effective non-hormonal treatment for hot flushes is clonidine HCL( DIXARIT®). This is a low dose of a blood pressure pill that is active in the brain region making hot flushes. The dose is titrated (increasing dosage until effective) by your family physician. - EFFEXOR® is an antidepressant which may be of benefit.   The usual dose is 37.5 mg once or twice a day.  - If DIXARIT® is not effective, some women have found that hot flush symptoms are minimized by first trying Vitamin E (400-800 International Units/day), taken at bedtime. - If Vitamin E is ineffective, some women have been helped by evening primrose oil per dose on package (obtainable from health food store).  Other options include soy, black cahoosh, REMINOFEN®.
Osteoporosis	- Exercise, (1/2 hour, 3 - 5x/week) and calcium supplements total of 1500-2000 mg/day plus a multivitamin giving 400 I.U. of vitamin D. - Bisphosphonate medications (ELENDRONATE®) have recently been shown to increase bone mass. If a bone density test shows significant bone loss, these medications are safe and can be prescribed by your family MD.  FOSAMAX® can be given as a 70 – 80 mg dose once a week which is often more well tolerated.
Vaginal Dryness / Painful Intercourse	- Water soluble lubricant (K-Y JELLY®, MUKO JEL®) (avoid vaseline) applied to head of penis and opening of vagina. - REPLENS® can be effective in some women. - If the above is unsuccessful, local application of a small amount of estrogen containing-vaginal cream to the opening of vagina, (rather than interiorly) may be recommended after consultation with your doctor. After daily treatment for 1-2 weeks, the cream is usually only needed once per week. - ESTRING® is a ring that stays in the vagina for three months at a time and provides local estrogen to the area.  Blood levels of estrogen are not apparent after the first 24 hours.

REFERENCE: Theme Issue: Menopause. BC Medical Journal vol. 35 (9) Sept. 1993: 650-664.

Woman who has never had breast cancer

Symptoms of the menopause may best treated by hormone replacement therapy (HRT). However, women with the following conditions should not be treated with estrogen-containing hormone treatments:

1. Known or suspected breast cancer or other untreated estrogen dependent cancer, such as endormetrial cancer;
2. Pregnancy;
3. Undiagnosed vaginal bleeding (could be endormetrial cancer);
4. Active thrombophlebitis (blood clots), or a history of thrombophlebtis related to birth control pills or during pregnancy.

Menopausal hormone treatment benefit is greatest for the first 5-10 years of use, and does not significantly increase the risk of developing breast cancer when taken for this length of time at a dosage of 0.625 mg of conjugated estrogens. Use of estrogens for longer than 10 - 15 years does increase the chance that a woman will develop breast cancer by approximately 1.5 times.

Diet and exercise are also helpful for menopausal symptoms, to prevent osteoporosis and heart disease. 

March 2007  We are currently reviewing and updating these pages.  If you have any questions about your cancer and its treatment, please discuss with your oncologist or physician.  Thank you.