In honour of Breast Cancer Awareness Month, Olivia wants to raise the profile of this disease and how it intersects with menopause. It’s a large, sprawling topic that can generate endless questions - and we’re sure you want the answers to them.
Perhaps you’ve heard that hormone replacement therapy (HRT) is unsuitable if you have a history of breast cancer? You might even be wondering if having breast cancer can impact how and when you experience menopause. Whatever you’re curious about, you’ve come to the right place.
You’ll first read through an explainer about what breast cancer is, including symptoms to look out for and advice on prevention. In the remainder of the article, we’ll explore how to navigate menopause if you have a history of this disease, as well as how cancer treatments can impact your menopause experience.
What is breast cancer?
Before we explore how menopause and breast cancer affect one another, it can be useful to understand what cancer is.
Cancer occurs when cells in the body grow uncontrollably. Normally, the body has systems in place to prevent uncontrolled growth, but occasionally they can be overridden. Your body also becomes less capable of doing this as you grow older, which is why your risk for cancer increases as you age.
In this process of uncontrolled growth, tumours can occur. They can either be benign, meaning they are (usually) not harmful, or cancerous. Cancerous tumours can spread to nearby tissue, and even to other parts of the body, in a process known as metastasis.
Who does breast cancer affect?
Breast cancer occurs, as the name suggests, in the breast, which is why it is so common amongst cisgender women. According to one study, trans men face a lower risk of breast cancer than cisgender women, and trans women are at a higher risk when compared to cisgender men. In this article, the term ‘women’ will refer to cisgender women, as this is where the majority of the research is centred.
Because the risk of cancer increases with age, breast cancer is most commonly diagnosed in older women, with 8 out of 10 cases occurring in postmenopausal women over the age of 50. Such numbers can feel intimidating, or even overwhelming, but the good news? Recovery is likely if the cancer is discovered early on.
There are many different forms of breast cancer, which can impact which type of treatment is suitable for you - but we’ll explore this in the next section.
Symptoms of breast cancer
The following symptoms can be an indication of breast cancer:
A lump or area of thicker breast tissue
A change in your breasts’ size or shape
Swelling or lumps in the armpit area
Dimpling around nipple area
A rash around nipple area
Any change in nipple appearance, e.g. becoming inverted
Though not all lumps are cancerous, it’s important to always have a doctor check them out in order to be certain.
Be breast aware
Without a doubt, the best way to notice any changes in your breasts is to get into the habit of checking them! Getting fully acquainted with your breasts, and how they look and feel, means it’ll be easier to notice any differences if they do occur. This can help in the process of early diagnosis, making a full recovery more probable.
The best way to check is by looking and feeling around your breasts on a monthly basis, being particularly alert to any changes in appearance or texture. Don’t forget to check around your collarbone and armpits, as breast tissue grows here as well.
And just a reminder that, because any gender can get breast cancer, everyone should all be checking their breasts/chest area.
Risk factors
There are a variety of things that may increase your risk of developing breast cancer, such as:
Your age
A family history of breast cancer
A previous diagnosis
Being overweight or obese
Having dense breasts
Consuming alcohol
Exposure to hormones and hormonal medicine
The causes of breast cancer are complex, especially the role of hormones. You can read about the causes in more detailed information here.
Family history
You may be at a higher risk of developing breast cancer if you have close family members who have previously experienced this form of cancer, or ovarian cancer.
That said, breast cancer is the most common type of cancer for women to develop. It is therefore possible for it to occur within the same family by chance.
If you know that someone in your family has experienced breast or ovarian cancer, you should speak to a doctor, who may be able to refer you to a suitable test.
Prevention
Because no one is quite sure what exactly causes cancer, there is no definitive way to prevent the development of this disease completely. As concerning as that may sound, there are still things you can do to reduce any potential risk factors, including:
Keeping a healthy weight
Practising regular exercise
Having a low saturated fat intake
Not drinking alcohol
Now we’ve covered the basics of breast cancer. But how, exactly, does this disease impact your menopause experience?
Navigating menopause after breast cancer
You may have entered menopause ‘naturally’, at a similar age to others. Alternatively, menopause may have been quite the uninvited guest after rounds of chemotherapy or radiation therapy. Wherever you are in your menopause journey, and no matter your age, the type of treatment you use to manage your symptoms needs to be considered carefully. It is likely that you will need to avoid HRT and explore other options.
If you have experienced early menopause due to cancer treatment, you will find specific advice after this section on symptom treatment. Early and premature menopause can come with their own set of health risks that you should be aware of.
And finally, before we begin, it’s important to note that research in this area is often changing. Though Olivia has used the most recent data available, it’s best that you always discuss with your doctor and/or oncologist to find out the most up-to-date information. This article is intended to give you a general overview of the treatments available, rather than providing specific medical advice.
Breast cancer treatment and menopause
The type of breast cancer that you have had will impact the type of menopause treatment that is appropriate for you. This is because some cancers have receptors for oestrogen or progesterone (or both). If a cancer is hormone receptor-positive, this allows hormonal therapies to block these receptors in order to eradicate the cancer. However, if the cancer is responsive to certain hormones, this also means that HRT could cause the cancer to grow back.
This is why hormonal treatments for menopausal symptoms are often ‘contraindicated’, or not suitable for use, for breast cancer survivors. There have been various studies to test this theory over the years, often with conflicting results, but two large trials in 1997, HABITS and Stockholm, were stopped early due to safety concerns over breast cancer recurrence. For the time being, HRT is not considered appropriate for anyone who has experienced breast cancer.
There are some occasions where HRT may be suitable despite a history of breast cancer, which will be explored at the end of this section.
Non-hormonal treatments for menopause
Though HRT is rarely suitable to treat menopausal symptoms if you have had breast cancer, the good news is that there are other treatments available.
There are a variety of non-hormonal medications available to treat menopausal symptoms. You can speak to your doctor and/or oncologist to find out what is available and what is suitable for you.
Non-hormonal lubricants and moisturisers
There is a large variety of non-hormonal vaginal lubricants and moisturisers for those dealing with vaginal dryness, amongst other symptoms. In particular, silicone-based lubricants have been shown to be superior compared to water-based lubricants for those with a history of breast cancer. Olive oil is another option to explore.
Pelvic floor relaxation exercises can help if you are experiencing painful sex.
Vaginal oestrogen
Vaginal oestrogen is often used to treat symptoms such as vaginal dryness, itching and pain. It is commonly available as an over-the-counter product in the majority of pharmacies. The use of vaginal oestrogen by those with a history of breast cancer is still up for debate, though some research suggests that it may be safe to use in low doses. Discuss with your doctor to find out whether this is suitable for you.
Your body will absorb some levels of oestrogen, though it is considered to be low enough to normally be safe. However, vaginal oestrogen is unlikely to be appropriate if you are taking aromatase inhibitors. As this medication for breast cancer works to keep oestrogen levels as low as possible, any absorption of oestrogen from a topical treatment can work against it.
Medication-free treatment
Perhaps you would rather avoid taking medication for your menopause symptoms, or you’re simply curious about trying an alternative route. If that is the case, then there are many lifestyle changes you can undertake in order to reduce the severity and frequency of your symptoms.
Funnily enough, the Olivia app offers a large variety of programs that promote symptom relief by building healthy habits. Sound interesting?
Though everyone responds differently, you may be surprised at what a few tweaks to your everyday routine can do for managing symptoms. We offer programs to address the following menopausal concerns:
Sleep issues
Stress
You will find all our programs in the Olivia app and we’re adding more all the time! You can also explore our blog for even more expert guidance.
When HRT might be suitable
There are a couple of occasions in which HRT may be appropriate to treat menopause symptoms, despite a history of breast cancer.
As noted above, the type of cancer you have had can affect what treatment is available to you, with hormone receptor-positive cancers being the main reason for avoiding HRT. However, not all cancers are hormone receptor-positive.
A third of women with breast cancer are diagnosed with either triple negative or HER2-positive, oestrogen receptor-negative cancer. In these cases, HRT should theoretically be suitable, due to a lack of oestrogen or progesterone receptors. Of course, it is vital that you speak to your doctor and/or oncologist in order to be sure.
Alternatively, you may want to consider HRT if non-hormonal treatment doesn’t work, and your menopausal symptoms are very severe and impacting your quality of life. Again, it is important to discuss this with a healthcare professional in order to receive an individualised treatment plan.
We have now covered all the different avenues for symptom relief in menopause, but one more topic remains that we need to grapple with. Namely, what happens if your cancer treatment has caused you to enter menopause early?
Induced menopause
‘Induced menopause’ means that menopause has been caused by medical treatment, such as surgery, radiation or chemotherapy. Just as someone going through a more traditional shift in hormones, you are likely to experience a variety of associated symptoms. Unfortunately, these symptoms may be more severe and appear more abruptly than those associated with ‘natural’ menopause.
The age at which you become menopausal is also important, as doing so at a young age presents its own set of health risks.
Health risks associated with early/premature menopause
Early menopause means that you experience menopause between the ages of 40-45. If you become menopausal before the age of 40, this is called premature menopause.
As if going through this seismic shift wasn’t enough, there are also certain health risks associated with experiencing menopause earlier than average. This is due to the premature loss of oestrogen, a hormone that affects many things in the body. In particular, oestrogen protects your bones and heart health.
Normally, someone experiencing early or premature menopause may use HRT or the contraceptive pill to restore their oestrogen levels and look after their bones and heart. However, neither HRT nor the contraceptive pill is likely to be a suitable option if you have a history of breast cancer.
If this is the case, there are a number of non-hormonal treatments you can try, such as:
Low-dose vaginal oestrogen for vulvovaginal atrophy
Increased calcium and vitamin D intake and weight-bearing exercise to protect bone health
Therapy for mood issues
Lifestyle changes, such as regular exercise and a healthy diet, to reduce the risk of cardiometabolic issues (such as heart attack, stroke, diabetes, insulin resistance, and more).
Navigating breast cancer and menopause
Breast cancer and menopause are two weighty topics, with their own set of complications. It’s not always easy to remain hopeful and positive, but we hope this article goes some way in offering you some guidance and advice to get started with.
Though it may be a bit of a minefield to begin with, you always have options to explore. We believe in you.
Disclaimer: This website does not provide medical advice. The information, including but not limited to text, graphics, images, and other material contained on this site are for informational purposes only. No material on this website is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new healthcare regimen. And never disregard professional medical advice or delay in seeking it because of something you have read on this website.
References:
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“Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause.” https://doi.org/10.1016/j.fertnstert.2016.09.046. Accessed 17 October 2022.
“Premature menopause or early menopause: Long-term health consequences.” https://doi.org/10.1016/j.maturitas.2009.08.003. Accessed 17 October 2022.
“Symptoms and treatment in cancer therapy-induced early menopause.” https://doi.org/10.1634/theoncologist.11-6-641. Accessed 17 October 2022.
“Using menopausal hormone therapy after a cancer diagnosis in Ireland.” https://doi.org/10.1007/s11845-022-02947-6. Accessed 17 October 2022.