Early Menopause
Some treatments for breast cancer can negatively impact a patient’s sexuality and sex life, primarily by catalyzing early onset of menopause. The results of breast surgery may also impact a patient’s sex life. Education about the effects of early menopause or breast surgery and options for treatment can help alleviate the impact of these treatments on a patient’s quality of life.
Menopause is the permanent cessation of menses that results from the end of cyclical hormone secretion by the ovaries. Breast cancer treatments that may stimulate early menopause are surgery to remove ovaries, radiotherapy to the pelvis, hormone therapy, or chemotherapy.
Many changes occur in the body as a result of menopause, and some of these may affect a woman’s sexuality or sex life.
Loss of fertility-- especially if it is as a result of treatments, and thus unexpected—can be very upsetting to women, even if they have a family or did not intend to have children.
Hot flushes resulting in night sweats and sleep disturbances can make a woman tired and irritable, thereby affecting sexual desire.
Depression or mood changes may have an impact on a woman’s primary erogenous zone, her brain, undermining sexual desire.
Vaginal dryness can make sexual relations uncomfortable or even painful.
These changes can be more severe when menopause is brought on suddenly, as in breast cancer treatment, than when menopause occurs naturally. Furthermore, because they are unexpected, these changes can be very psychologically difficult for some women to cope with. Thus, appropriate treatment options should be considered to help reduce the shock of these unexpected changes and improve a woman’s quality of life.
Systemic treatment: One treatment option for alleviating the changes from menopause is to supplement the reduced hormone levels in a woman’s body with hormone replacement therapy (HRT). The term “replacement” is somewhat of a misnomer, because HRT provides only a small fraction of the hormones once produced by the ovaries. In most cases, HRT will reverse the negative effects of menopause, particularly hot flashes, vaginal dryness, and depression.
A number of factors need to be considered when a woman considers HRT. One of these is the hormone status of her cancer. Hormone dependent cancers, such as breast cancer, can be stimulated by HRT. However, some low dose treatments may be possible. There is not a “one size fits all” approach when it comes to menopause therapy. Each woman is unique, and, with the guidance of her health care provider, must make her own decisions.
Local treatment: Some changes from menopause may be treatable at the local level, such as vaginal dryness. Vaginal changes occur as a result of the decrease in internal estrogen levels during menopause. This estrogen decline can cause tissues of the vagina to become thin, dry, and less elastic—a condition known as atrophy. Thus, the vaginal lining becomes easily inflamed or injured, and may bleed, particularly during sexual relations. Also, the natural lubricating and cleaning process does not function properly, which can result in more likelihood of vaginal infections.
For milder cases of vaginal dryness, non-hormonal creams that can be bought over the counter, such as KY jelly, may be helpful. Also, regular exercise has been shown to maintain vaginal health. For more severe cases, vaginal estrogen can effectively restore thickness and elasticity of these tissues. Vaginal estrogen is available in the form of a cream, tablet, or ring that is applied into the vagina about twice a week. Because these products are topical, only a small amount of estrogen is absorbed. Thus, even women with hormone dependent cancers may be able to utilize this treatment option.
Breast surgery or radiotherapy may also negatively impact some women’s sex life. For many women, the breasts are deeply sensitive and an essential component to sexual arousal. Surgery or radiotherapy causes a loss of sensation in the affected area. The extent of this loss depends on the extent of therapy. While a double mastectomy, removal of both breasts, will eliminate all sensation in the breasts, a lumpectomy, removal of the cancerous tumor, may only compromise sensation in a limited area, depending on where the lump was.
Breast surgery can also impact a woman’s sex life because of the change in her appearance. Some women find the scarring that results from breast surgery to impact their ability to feel attractive. Again, the extreme example of this is in the case of a mastectomy. Breast reconstruction is one option for these women. However, this procedure will not return lost sensation.
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