Managing Menopause

Whether breast cancer treatment has forced you into menopause or you've already gone through the transition naturally, you may now be experiencing many changes in your body brought on by the decrease of estrogen. Hormone replacement therapy (taking estrogen pills) is not recommended for women with breast cancer. But there are ways to help manage changes brought on by menopause that do not involve taking estrogen.

Osteoporosis is a disease that weakens bones and makes them more likely to fracture. A person with osteoporosis usually has a normal rate of bone formation but an increased rate of bone loss. It's estimated that osteoporosis causes 1.5 million fractures each year in the United States, primarily of the hip and the spine. There are usually no symptoms until fractures occur; however, backache, spontaneous fracture, or loss of height may lead to the diagnosis of osteoporosis.

Because the condition affects more women than men and typically occurs in middle age, some doctors are now calling it postmenopausal osteoporosis. Most cases of postmenopausal osteoporosis result from estrogen loss associated with aging, although other factors such as family history, smoking, alcoholism, and diseases such as uncontrolled diabetes and rheumatoid arthritis may play a part.

Bone density of the lower spine and hip can be determined using a test called dual energy x-ray absorptiometry (DXA), with scores above 1.0 considered normal and scores below that number indicating osteopenia (low bone density) or osteoporosis.

Based on bone density findings, treatment options are tailored to individual patients. They may include exposure to sunlight; a diet that contains adequate calories and sufficient amounts of protein, calcium, and/or calcium supplements, and vitamin D and/or vitamin D supplements; exercise; and certain medications that slow bone loss or build new bone.

Approximately 90% of women going through menopause will experience hot flashes. A hot flash is a warm feeling followed by redness. It is sometimes followed by a hot flush, which is sweating in the face, neck, and/or chest. Hot flashes can happen during the day or, more commonly, at night, and night sweats can interfere with sleep in many women. Feelings of fatigue, depression, and irritability that were once attributed to going through menopause may actually be the result of constant sleep interruptions due to hot flashes. Hot flashes and flushes tend to lessen over time and generally disappear after one to five years. Talk with your doctor if your hot flashes are affecting your normal activities.

Menopause is a good time to think about your health as well as exercise and diet habits. Be sure to talk with your doctor before beginning an exercise program or changing your diet.

There is no evidence that menopause itself makes women more likely to develop depression. However, events that may occur around the time of menopause may trigger depression.

Sadness and grief are common in all patients with cancer at various stages of diagnosis and treatment. These feeling are normal. They are reactions to what people face during cancer. People may experience different levels of stress about the following issues

• Fear of dying
• Changes in self-esteem and body image
• Financial concerns
• Interrupted plans, role in life, and lifestyle

Up to 25% of cancer patients may experience depression. This may happen to a cancer patient who cannot accept the diagnosis of cancer. Those patients not interested in their usual activities may also be depressed.

Talk with your doctor about any difficulties and/or worries you may have. Counseling may help. Also consider joining a support group to share your feelings and experiences with other women with breast cancer.

Women going through menopause generally report various symptoms, memory loss being one of them. However, studies have shown that memory loss is no more common in women experiencing menopause than in women not experiencing menopause. It is possible that memory loss in women going through menopause results from frequent hot flushes or interrupted sleep.

The hormonal changes associated with menopause may not be the sole cause of weight gain. Exercising less, eating more, and burning fewer calories may contribute to weight gain during menopause.

Weight gain during menopause may also increase a woman's risk of developing breast cancer. In fact, women who gain more than 20 pounds after menopause increase their risk of getting breast cancer by 20%. Losing weight, however, can reduce a women's risk of getting breast cancer. A woman who loses 20 pounds after menopause reduces her risk of developing breast cancer by 23%. Even taking off smaller amounts of weight can help reduce the risk of developing breast cancer.

Things you can do to prevent or reverse weight gain include increasing physical activity and watching your diet. Be sure to talk with your doctor before beginning an exercise program or changing your diet.

Lower estrogen levels may lead to vaginal dryness, which can result in vaginal inflammation, not enough lubrication, and pain during sexual intercourse. Talk with your doctor to see if over-the-counter-lubricants, a certain type of vaginal exercise called Kegel exercises, and/or frequent sexual intercourse may help.