History of cancer: can I still get treatment for menopause?
Relieving your menopause symptoms when you have a history of cancer can involve many extra steps depending on the complexity of your case.
Women can have severe symptoms that mean taking time off work or giving up their jobs entirely so understanding what is available to you if you’ve had cancer, is important.
Risks of treatment
GPs are cautious about prescribing HRT to women who have a history of certain cancers such as cervical, ovarian, uterine, and breast. This is because early studies into the side effects of HRT showed a borderline increased risk amongst certain age-groups.
There is now more understanding of the risks and benefits of HRT today than when the first studies took place.
“Many women suffer because they or their practitioners think it is not possible for them to have hormone therapy, but if you carefully weigh up the pros and cons, it is possible with tailor-made treatments,” explains Mr Nick Panay, Consultant Gynaecologist.
Cervical, Vulva, Vagina
Women who have had vulva, vagina or cervical cancer can be prescribed HRT for treatment of the menopause symptoms, although this is not according to the HRT product license (off label). If your GP is unsure, you can request a referral or second opinion.
Ovarian and Uterine
For ovarian cancer, the data from randomised trials so far look encouraging. However, there is still a need to be cautious before prescribing HRT for women who have a history of ovarian cancer.
In the early stages of uterine cancer, stages 1 and 2, there has been a trial which has suggested there is no increase in risk of recurrence from HRT. There are not enough clear data yet to fully understand the risk posed with more advanced stages of uterine cancer.
For both ovarian and uterine cancers, you should be referred to a menopause specialist for treatment of your menopause symptoms.
Breast
Studies looking at the impact of HRT on breast cancer recurrence were terminated early following the outcomes of the Women’s Health Initiative (WHI) study in 2002.
When the full data from WHI were analysed, it was found that when broken down by age, the small increase in risk was 1 in every 1000 women per year and not increased in women on estrogen alone.
“If somebody is suffering and they have had past issue with cancer, they need to see a specialist to discuss whether HRT is an option for them,” say Mr Panay, “but to also look at alternative options to reduce the symptoms and enable them to sleep.”
However, women who are suffering from menopausal symptoms and have a history of breast cancer should see a menopause specialist first before taking HRT.
Alternative therapies
There are other pharmaceutical therapies that may give women a break from their symptoms. This includes treatment that can block the signals coming from your brain to your nerve receptors which can help relieve hot flushes and sweats. Again, it is best to consult your specialist for expert guidance.
“For women with those symptoms, this new treatment option is going to be really effective, up there with HRT,” explains Mr Panay.
Vaginal Estrogens
If you have had breast cancer that is sensitive to your hormones, (known as a hormone receptor positive tumour), you might be able to use vaginal estrogens (off label) to help with your menopausal symptoms if you are on tamoxifen. As the estrogen is local and not absorbed through the body, it makes it safer to use.
This also applies to women who have had a deep vein thrombosis (DVT) and may have fewer options for treatment of their symptoms.
Tailored HRT
Menopause specialists are now able to individualise HRT more accurately. Studies have shown that doses of hormones need to be age-appropriate and that using natural progesterone has less impact on the risk of developing breast cancer. Hormones used in regulated bioidentical HRT have the same structure as those produced by your ovaries.
The information about your lifestyle, medical, and family history, is also important in tailoring the treatment for your needs.
Hormone Health only use regulated preparations that are tested for effectiveness and safety.
Specialist clinics
As there are only a limited number of GPs who specialise in the menopause, many GPs are not aware of what hormone therapy options are available and/or have not read the latest guidelines yet.
Overall, treating the symptoms of the menopause is about optimising your quality of life. Doctors will take this into account when looking at what treatment is available, as well as your wishes.
You can always ask for a referral or a second opinion if you feel that you want to explore more options.