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Breast cancer and medical menopause FAQ

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Being diagnosed with breast cancer and going through treatment can be an overwhelming experience, especially for younger, premenopausal women. The treatments can include an induction of early menopause, known as medical or treatment-induced menopause. This brings a whole new set of challenges with menopausal symptoms on top of dealing with the cancer itself. Here are some common questions from our breast cancer community of patients have about medical menopause and ovarian function suppression:

What is ovarian function suppression?

Ovarian function suppression (OFS) refers to treatments that stop the ovaries from producing estrogen. This is often done by using medications called gonadotropin-releasing hormone agonists (GnRH agonists) like goserelin (Zoladex) or leuprolide (Lupron). These drugs essentially put the ovaries into a temporarily inactive state, mimicking menopause.

Surgical removal of the ovaries (oophorectomy) is another form of permanent ovarian suppression and some chemotherapy drugs can cause temporary or permanent menopause by damaging the ovaries.

Can ovarian function return after medical menopause induced for breast cancer treatment?

Yes, in cases where OFS is used, ovarian function may return after the treatment is discontinued. However, this depends largely on the patient’s age, the duration of treatment, and individual response to the therapy. For younger women, the likelihood of regaining ovarian function is higher compared to older women. Conversely, surgical removal of the ovaries (oophorectomy) results in permanent menopause.

Why is OFS used for breast cancer treatment?

Many breast cancers are hormone receptor-positive, meaning the cancer cells are fueled by estrogen. Suppressing ovarian function and lowering estrogen levels can help slow or stop the growth of these cancers.  OFS is often used in combination with other hormone therapies like tamoxifen or aromatase inhibitors in premenopausal women with hormone receptor-positive breast cancer.

What menopausal symptoms can OFS cause?

By lowering estrogen levels, OFS can induce menopausal symptoms like:

  • Hot flashes/night sweats
  • Vaginal dryness
  • Loss of libido
  • Mood changes
  • Sleep disturbances
  • Joint/muscle aches
  • Bone loss over time

The symptoms can be quite severe since the drop in estrogen happens abruptly rather than gradually like in natural menopause.

How can I manage these menopausal symptoms?

There are non-hormonal options that may help relieve symptoms like hot flashes, vaginal dryness, sleep issues, and bone loss. These include:

  • Medications like certain antidepressants, gabapentin, or oxybutynin
  • Vaginal moisturizers and lubricants
  • Pelvic floor physical therapy
  • Lifestyle changes like exercise, yoga, and relaxation techniques
  • Bone-building medications like bisphosphonates

Managing these side effects is an important part of treatment, and options include lifestyle changes, hormone replacement therapy (specifically tailored and carefully considered due to breast cancer history), and medications to address bone density issues. It’s important to discuss management strategies with your oncologist, as some options may not be recommended depending on your breast cancer type and treatments.

Will I be able to get pregnant after OFS?

For many women, ovarian function and fertility can return after stopping OFS medications, though this depends on your age and how long you were on the drugs.  However, OFS is not recommended solely for the purpose of fertility preservation before breast cancer treatment. Other fertility preservation methods like embryo or egg freezing should be discussed if you want to have children in the future.

How long will I need ovarian suppression?

The recommended duration of OFS is typically 5 years when combined with other hormone therapies like tamoxifen or aromatase inhibitors for high-risk early breast cancers.  Your oncologist can discuss the appropriate length of treatment for your specific situation. Having open conversations with your cancer care team about medical menopause is important for getting the support and management you need. Don’t hesitate to ask questions and voice any concerns you may have.

Navigating the challenges of breast cancer treatment, particularly those involving medical menopause and ovarian function suppression, can feel daunting. It’s crucial to have access to reliable information and support to manage both the physical and emotional impacts. Understanding the medical processes and reasons behind the recommendations,  and their implications helps in making informed decisions about your health and treatment options.

To effectively track and manage your menopause symptoms and connect with a supportive community, consider using the Outcomes4Me app. This tool allows you to easily track your symptoms, access personalized treatment information, and tap into a network of peers and professionals. Embrace a proactive approach to your health by downloading Outcomes4Me today, and empower yourself with knowledge and support at every step.

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