Dr. Lisa Jervis, MD, is part of The After Cancer's Care Team. She's board-certified in both Obstetrics/Gynecology and Integrative Medicine.
If it’s not one thing, it’s something else!
Congratulations…you have been through a lot both physically and emotionally to get to this point. This is definitely something to appreciate, if not celebrate. Menopause will come eventually—whether by natural progression of the aging process or by “early invitation.” Many survivors don’t purposefully send that early invitation, but either by surgical intervention, chemotherapy, or anti-estrogen treatments, the door is opened sooner than anticipated.
Menopause affects everybody differently.
Some women breeze right through with minimal symptoms; some women are miserable day and night, but most women fall somewhere in between those scenarios. The good news is that there are many integrative approaches to lifestyle choices and options to help with symptom management. No matter the cause of menopause, healthy lifestyle choices are always recommended when possible.
The changes can affect how we feel almost immediately
The changes associated with menopause are mostly due to decreasing levels of female hormones (estrogen and progesterone) and male hormones to a lesser degree. These changes can affect how we feel almost immediately with common symptoms of hot flashes, night sweats, anxiety, sleep disturbances as well as genito-urinary dryness, discomfort, and decreased libido. Not only do we experience these irksome symptoms, but the decreased hormone levels (which were once protective of our health) are now setting us up for an increased risk of cardiovascular disease, stroke, bone loss (osteoporosis) as well as changes in brain health, skin and gut health.
The big picture of your health
I always like to start with the “big picture” of overall health, as that’s what this is all about! An “Anti-inflammatory” or Mediterranean style eating pattern is beneficial for almost any condition or ailment. With regard to menopause and survivorship, I would encourage ample intake of plant-based (not necessarily vegetarian) and whole foods (avoiding/limiting simple sugars and processed foods). Emphasize foods rich in calcium, Vitamin D, omega 3 fatty acids, anti-oxidants (fruits, vegetables, green tea, etc), fiber (whole grains, beans, legumes), whole soy foods, and consider adding fermented foods (for the microbiome) and cooked Asian mushrooms. I cannot stress the importance of some form of activity/movement or exercise to help with everything from decreased risk of cancer recurrence, bone loss and dementia as well as protection of cardiovascular health and alleviation of many of the menopausal symptoms discussed previously.
Integrative treatments for symptoms of menopause
By definition, integrative treatments for symptoms of menopause can incorporate both conventional medical and more natural (non-pharmaceutical) options. The most effective known treatment for symptoms of menopause is hormone therapy, which may be appropriate for some women. However, for many survivors of breast cancer, especially hormone receptor-positive cancers, systemic hormone therapy is not an option. Fortunately, there are many options to help you that are safe in this setting.
Consider the following summary of integrative options to manage menopausal symptoms (focusing on hot flashes):
Limiting intake of alcohol, sugar, and spicy foods may be helpful for some people’s hot flashes.
Using fans, weighted cooling blankets and pillows are simple changes that may be successful and easy to implement.
Herbal supplements such as Black Cohosh and Purified Pollen Extract have been used.
Other herbs include: Valerian, kudzu, hops and sage leaf. Essential oils: Clary Sage and Rose Geranium.
Studies have demonstrated that acupuncture can be beneficial in lessening hot flashes and anxiety associated with menopause.
Mind-body modalities such as guided imagery and clinical hypnosis are useful adjuncts.
Conventional non-hormonal medications such as venlafaxine (Effexor) and neurontin (Gabapentin), that may help reduce hot flashes, are some of the first line options recommended by oncologists. These medications are traditionally used for other purposes such as depression, anxiety and pain modulation. They can be associated with a fair amount of side effects and are not always tolerated.
Recent developments
2 fairly recent developments of conventional options for menopausal symptoms have been published. In May 2023, the FDA approved a successful non-hormonal treatment called Fezolinetant which helps control the thermoregulatory center in the brain, significantly reducing the amount of hot flashes experienced in subjects. Also good news with regards to genito-urinary syndrome of menopause (aka vaginal dryness or discomfort) was published in the most recent Journal of Obstetrics & Gynecology. A large analysis did not find an increased risk of breast cancer recurrence within 5 years in women with a personal history of breast cancer who were using vaginal estrogen for their symptoms. This included women with estrogen receptor positive cancers.
Although we can’t stop menopause from finding us—we can work together to take control and move forward in health, peace, and comfort.
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