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Special Concerns for Breast Cancer Patients

Women who have had breast cancer or who are at increased risk for breast cancer due to a strong family history or other factors may have special concerns about seeking treatment for the bothersome symptoms that often occur during menopause.

During menopause, decreased estrogen levels leads to hot flashes, night sweats, insomnia, vaginal dryness, pain with intercourse and the loss of mineral in your bones. These symptoms can be more severe in patients taking Aromatse Inhibitors [Femara, Arimidex, Aromasin]. These drugs prevent the conversion of male hormones produced in the ovaries and the adrenal glands into estrogen.


The hot flashes, night sweats and insomnia are treated first with lifestyle changes: paced abdominal breathing, relaxation techniques, dietary changes, cool environment, light clothing and other techniques

Women who do not find significant relief of their symptoms after adopting these lifestyle changes may be offered non-hormonal therapy in the form of low-dose antidepressants. The FDA recently approved Brisdelle (which is low dose Paxil) for the reduction of hot flashes.

For vaginal dryness and pain with intercourse, regular use of non-hormonal therapy in the form of vaginal moisturizers (Luvena, Replens etc.) may be recommended. Vaginal lubricants may be used during intercourse.

If symptoms persist, after consultation with an oncologist, local low-dose vaginal estrogen may be used. The three main types of vaginal estrogen come in the form of a cream, ring or a vaginal tablet.

Data does not show an increase 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. Women who have a history of breast cancer should consult with their oncologist prior to beginning this treatment.

Chemotherapy and aromatase inhibitors cause your bones to lose minerals and can lead to osteoporosis. It is important that you have regular DXA scans to monitor possible bone loss, take daily calcium (dairy) and Vitamin D3 supplements, and exercise regularly.

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