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I can’t take HRT due to breast cancer battle – how can I ease menopause symptoms?

AFTER Sun Health’s menopause special last week, lots of readers got in touch with questions about their experiences of perimenopause and menopause.

It is really great that women are reaching out for information, but it is vital the details and support they need are widely available.

Dr Zoe Williams answers some common questions sent in by readers

Which is why The Sun’s Fabulous Menopause Matters campaign was launched a year ago, with three crucial aims:

  • Free HRT on the NHS for everyone.
  • Menopause support at the heart of workplace policies.
  • To bust taboos and help women thrive during the menopause.

So here are your menopause questions answered.

Q) MY partner has told me her doctor has recommended a contraceptive Pill to help her with menopause problems.

I thought HRT pills would be the ones, not a contraceptive?

A) The combined oral contraceptive Pill can sometimes be used in place of HRT to treat menopausal symptoms and prevent weakening of the bones (osteoporosis) in women under 50.

Like HRT, it replaces the hormones the body has stopped making, so can alleviate symptoms.

It is more likely to be recommended if the ­person is experiencing menopausal symptoms while still having periods (perimenopausal) and requires contraception at the same time. Or it may be the woman’s preferred choice.

The combined oral contraceptive Pill is not ­usually advised if the person is over 35 and smokes, has obesity, or has a history or family ­history of blood clots.

A) I’M 51 and am certain I’m going through the menopause.

I have all of the symptoms and just don’t feel like myself any more.

In my family we don’t really talk about this type of thing, and I don’t know where best to turn for help. I don’t think I want HRT, so I haven’t seen my GP.

A) We keep hearing we should be ‘talking’ about our menopause and sharing our experiences.  

However, for many people this isn’t something they feel comfortable with or able to do.

We have to remember we are all different, with different cultural, religious, ethnic and social ­backgrounds, which affect how we experience the world around us.

Having said that, it is really important to find a way to share what you are going through and access support.

One way is online via others that are experiencing something similar.

I’ve been working with, who have formed a community online for those experiencing perimenopause and menopause.

There’s lots of great information there because “knowledge is power” when it comes to ­menopause. You can always speak to your GP, whether that’s about HRT or the many other ways in which they can support you.

Sometimes people feel more comfortable ­making an appointment with the practice nurse to discuss this, and that’s fine too.

It’s also worth checking with the reception staff to see if any of the clinicians have a special interest in menopause, especially if you are registered at a large practice.

Q) IT is great The Sun is highlighting the ­problems women are having, but there’s never anything mentioned about women who have gone through breast cancer.

I was ­diagnosed in 2019, had a lumpectomy, then went on to have chemo and radiotherapy.

All went well and now I’m cancer free. My treatment continues for five years taking Tamoxifen daily.

This is a hormone suppressant so it starts you off into the menopause.

Having had cancer which feeds off your hormones, I’m not able to take HRT or use treatments that contain any hormones.

I feel this should be highlighted because I know I’m not the only one suffering but unable to get any help to relieve the ­symptoms.

A) You are absolutely not alone. In fact one in seven women will get breast cancer, making it a relatively common disease.

With advances in treatment, more than eight out of every ten women with breast cancer will survive. So it’s more important than ever that breast cancer survivors are able to have optimal quality of life.

When it comes to menopause, this is quite tricky because HRT is not usually recommended for women after a diagnosis of breast cancer.

And to add insult to injury, many of the ­treatments for breast cancer can exacerbate, or bring on, menopause symptoms earlier.

There are some non-hormonal treatments that can sometimes be prescribed for certain ­symptoms, such as SSRI antidepressants which can help alleviate hot flushes in some women who can’t take HRT, though this may not be ­possible while taking Tamoxifen.

You may be able to overcome some vaginal symptoms with vaginal moisturisers or lubricants, and some cancer ­specialists will consider prescribing topical oestrogen pessaries, tablets, cream or a ring, which delivers the oestrogen directly to the vagina.

You can talk to your treatment team about how they can support you, and if you are still ­struggling, I would advise requesting a referral to a menopause specialist.

In exceptional circumstances, some menopause specialists may offer HRT to women with severe menopausal symptoms when the risks are fully understood.

Q) I AM a 47-year-old nurse going through perimenopause. I am not taking HRT and stopped my contraceptive Pill in May.

Over the past few months, my menopause symptoms have become more noticeable – hot flushes, night sweats, brain fog, fatigue and low concentration.

I have noticed my vaginal area, radiating to my groin and inner thighs, has become extremely itchy. It has got so unbearable, I’ve made myself bleed by scratching myself vigorously.

My GP suggested an oestrogen cream to administer ­internally for the dryness.

However, I’m not experiencing the itchiness internally but more so externally, leaving my skin red, excoriated and very sore.

Do I need any ­further creams?

There is a family history of breast cancer and I have suffered from DVT post-operatively, so I’m quite apprehensive about starting HRT.

Would you suggest the contraceptive Pill?

A) It may actually be safer for you to take transdermal HRT than the combined oral contraceptive Pill, as when HRT is delivered by gel to the skin, there is no increase in risk of blood clot.

It’s only when taken in tablet form that there is a small increase in risk.

There is no strong evidence that having a family history of breast cancer puts you at any higher risk of getting it if you take HRT.

Oestrogen cream, or other topical oestrogens, such as gel, pessaries or vaginal rings, can be highly effective at treating the genitourinary (genital and urinary) symptoms of perimenopause and menopause, and they are completely safe too, as the oestrogen only acts locally in the tissues of the vagina, vulva, bladder and urinary tract.

Oestrogen is important for maintaining the health and integrity of these tissues.

Loss of oestrogen, due to menopause, can cause the tissues in the walls of the vagina to become thin, dry, and sometimes inflamed.

The skin on the vulva can also be affected.

The cream is applied into the vagina, using an applicator at bedtime.

This allows the medicine to be absorbed into all of the surrounding tissues including the vulva.

However, there is no harm in rubbing some of the oestrogen cream directly on to the affected area too.

If you notice no difference after a few months, return to your GP as there could be another cause behind your symptoms.

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