Non-hormone based medications for early menopause symptoms after oestrogen-sensitive cancers: Health Practitioners’ perspectives

Women who experience early menopause (EM) or menopausal symptoms due to treatment for oestrogen-sensitive cancer are usually not able to take systemic Hormone Replacement Therapy (HRT), also known as Menopausal Hormone Therapy (MHT). Alternative non-hormonal medications for EM symptoms include clonidine, some antidepressants (for example, venlafaxine), gabapentin, and pregabalin. These medications can help reduce vasomotor symptoms including night sweats and hot flushes, and may help some women with sleep and mood difficulties.

The health practitioners we interviewed explained how they discuss the options available to help alleviate EM symptoms with women with experience of oestrogen-sensitive cancer. In addition to non-hormonal medications, health practitioners discussed lifestyle changes, for example a healthy diet and regular exercise (see Lifestyle changes following early menopause), and complementary medicines and alternative therapies (see Complementary medicines and alternative therapies for early menopause). However, the safety and effectiveness of many herbal therapies in women with oestrogen sensitive cancer is unclear.

Vasomotor symptoms

Several health practitioners commented on the lack of non-hormonal medications for women with EM or menopausal symptoms due to treatment for oestrogen-sensitive cancer experiencing vasomotor symptoms. Dr S, a medical oncologist, explained that ‘most women don’t find drugs for the hot flushes useful … apart from giving women oestrogen, which we can’t do in an oncology clinic, there aren’t good drugs.’ Breast surgeon Dr Baker noted the importance of reassuring ‘people that [hot flushes] get better with time.’

Medical oncologist Dr S discussed the non-hormonal medications available for EM symptoms after oestrogen-sensitive cancer treatment.

Medical oncologist Dr Richardson explained that some non-hormonal medications for hot flushes have side effects.

Several health practitioners noted that some lifestyle changes (see Lifestyle changes following early menopause) can help reduce EM symptoms. Breast care nurse Ms Lewis explained: ‘we talk to them about reducing alcohol intake, reducing caffeine intake, dressing in layers, having the bedroom a few degrees cooler… Having the bedding in layers, having a fan, all these small things [can help] a lot of women manage the hot flushes.’

In addition, complementary medicines and alternative therapies (see Complementary medicines and alternative therapies for early menopause) were discussed by a few health practitioners as possible alternatives to hormonal medications.

Breast surgeon Dr Baker shared her experience of discussing with women lifestyle changes and complementary medicines and alternative therapies.

Sleep difficulties and emotional health

Health practitioners explained that some antidepressants may help with sleep difficulties related to EM. As medical oncologist Dr Richardson noted: ‘some of the antidepressants will sometimes help regulate sleep cycling … They work to some degree, they don’t work perfectly.’

In addition, some women may experience emotional challenges due to EM; health practitioners suggested that certain antidepressants combined with psychological therapies (see Psychological therapies and support for early menopause) may help. Dr C, an obstetrician-gynaecologist, remarked: ‘The good thing about SSRIs … is that … you can treat the mood a bit plus the flushes. Then you’ve got to do all the other stuff that’s not pharmacological, so … cognitive behavioural [therapy] and … whether acupuncture works for you, or whether you do more exercise…’

Professor Kulkarni, a psychiatrist specialised in women’s mental health, noted that Selective Estrogen Receptor Modulators (SERMs) can be helpful to women experiencing mental health difficulties.

Endocrinologist Dr W explained that while antidepressants can help some women with their EM symptoms, they have side effects and do not protect bone density.

Vaginal dryness and loss of libido

Health practitioners acknowledged that vaginal dryness and loss of libido could cause significant difficulties for women and their partners. Breast care nurse Ms Lewis observed that couples need to be offered information and resources on impact of EM on intimacy to support them: ‘The BCNA do some good ones on sexuality and menopause. I think that helps if [partners] have some idea of what the ladies are going through.’ (See also Fertility and early menopause)

Certain moisturising creams, pessaries or lubricants were recommended by health practitioners to help with vaginal dryness.

For Ms Lewis, a breast care nurse, using a vaginal moisturiser and increased time for foreplay can help women with painful sex.

Breast care nurse Ms Hay explained that she offers women samples of lubricants and reflected that couples need to ‘build intimacy’.

A few health practitioners commented that women and health practitioners can sometimes be hesitant to discuss EM symptoms related to sexuality. Dr Baker, a breast surgeon, commented that ‘[most women], I think, display a sense of relief that I’ve brought the topic out. Because even if you say “Is there anything else you’d like to talk about?” there’s quite a step for them to talk about vaginal dryness … me saying these things it’s a lot easier I think for the patient to then talk about it.’ However, Dr Baker also noted that ‘the resources for discussing sexual dysfunction are pretty poor…’

The use of vaginal oestrogen is controversial for women with experience of oestrogen-sensitive cancer. A few health practitioners felt that for some women, the risks associated with vaginal oestrogen were very low compared with the benefits.

However, for Dr S, a medical oncologist, ‘women are afraid of it, so even if you prescribe vaginal oestrogen – which by the way I wouldn’t do, I would send them to a menopause clinic – I would say most women would not take it.’

In obstetrician-gynaecologist Dr C’s experience, the management of vaginal dryness by health practitioners needs improvement and women should be given appropriate information on vaginal oestrogen.

Further information

Talking Points (Health Practitioners)

Talking Points (Women)

Other resources