BREAST CANCER SURVIVORS

Women with breast cancer may undergo treatments involving surgery, chemotherapy and/or radiation. They may go into induced menopause and develop menopausal symptoms.

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Many breast cancers are sensitive to the hormone estrogen, so systemic hormone replacement therapy is not an option. There are behavioral management and non-hormonal medications to help with hot flashes.

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Behavioral management includes wearing loose cotton clothing, lowering the temperature in your living environment, practicing yoga or meditation, paced breathing and avoiding triggers such as alcohol, caffeine and stress. It can also be helpful to work toward a healthy body weight and exercise regularly with a goal of 150 minutes/week of moderate physical activity.

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There are some non-hormonal medications which may help with hot flashes. Herbal remedies that have been studied have not been found to be effective. 

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For management of urogenital symptoms, there are vaginal non-hormonal and hormonal options as well as mechanical treatments such as pelvic floor physical therapy. 

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There are some safety concerns about the use of vaginal hormone therapy in women who currently have breast cancer or have a history of breast cancer. Non-hormonal approaches are the first-line choices for managing urogenital symptoms experienced by women during or after treatment for breast cancer. Vaginal estrogen is generally reserved for those patients who are unresponsive to non-hormonal remedies. The decision to use vaginal estrogen may be made in coordination with a woman’s oncologist.

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Data do not show an increased risk of cancer recurrence among women currently undergoing treatment for breast cancer or those with a personal history of breast cancer who use vaginal estrogen to relieve urogenital symptoms.

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Mechanical options increase blood supply to the vulvovaginal tissue. Sexual activity (with or without a partner) helps maintain healthy vaginal tissue and decreases vaginal dryness. Vaginal dilators and pelvic floor physical therapy can also be helpful for some women. There are also various vaginal laser procedures that are undergoing evaluation currently for treatment of vaginal atrophy. In the future these may be useful for women who cannot use the vaginal estrogens.

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Available data suggest that inducing changes in vaginal tissue with laser intervention can treat the symptoms of vaginal dryness. Laser therapies are not yet FDA approved as they currently lack long-term safety and efficacy data but they may be considered in women who prefer non-hormone treatments.