The team at Norfolk Menopause are keen to be able to help all women through their menopause, and this includes women who have had breast cancer.

“There is no getting away from the fact that a diagnosis of breast cancer can have huge implications for menopause” says Dr Cary. “Breast cancer treatment for some women may lead to an early menopause, while other women may have to abruptly stop HRT when they are diagnosed. And many women with breast cancer will have hormone-blocking treatment as part of their management which can cause particularly severe menopausal symptoms”.

“Management of menopause after breast cancer can be particularly challenging” agrees Dr Healy, “and we are very aware that many women with breast cancer feel excluded from all the excitement of the recent menopause conversation, which has largely focused on HRT. For women with breast cancer the seemingly ‘easy option’ is generally off the cards and I can’t imagine how frustrating and unjust this must seem.”

This definitely doesn’t mean that there is nothing that can help though. “Absolutely not, its just a whole different ballgame” says Dr Cary. “With an open mind and the right support there is no reason menopause can’t be managed well, but it can be difficult for women to know where to turn for advice.”

Here are some themes that came up during a recent educational evening in collaboration with the wonderful Starthrowers charity;

• Small changes in lifestyle can have a big impact. Studies have shown moderate exercise (150min a week) can reduce risk of recurrence by over 50%. This can seem a big ask, especially after cancer treatment, but remember anything is better than nothing. The concept of ‘movement snacking’, a couple of minutes at a time can help, and reduction in menopause symptoms that lifestyle changes can bring can be a great motivator.

• Stress can exacerbate menopausal symptoms. Cancer and its treatment is a huge stress, and of course ‘everyday’ life stresses don’t stop with a cancer diagnosis. Anything that reduces stress helps, this could be mindfulness for one woman and archery for another. Psychological therapies, particularly CBT (cognitive behavioural therapy) can be a powerful tool to reduce impact of symptoms by changing thought processes surrounding them and the feeling and behaviours that result.

• Non hormonal medications can help. Don’t feel fobbed off if you are offered antidepressants. Used for menopausal symptoms at menopausal (usually very low) doses these can really target troublesome symptoms. Venlafaxine can be especially helpful for flushing, duloxetine for pain and weight gain, and citalopram for anxiety. Women using Tamoxifen should not take fluoxetine or Paroxetine. Herbal treatments can have a role, though expert advice is needed to ensure these are used safety and effectively as they can have powerful interactions.

• Vaginal oestrogen is safe for most women after breast cancer. Genito-urinary menopausal symptoms can be particularly severe after cancer treatments, and though non -moisturizers and lubricants are always going to be first line there is robust safety data around using tiny doses of vaginal oestrogen. This needs more careful consideration for women on Aromatase Inhibitors.

• Systemic HRT after breast cancer is controversial and can seem polarizing, but those who want to know more should be helped to explore their options. It should not be a blanket ‘no’. The data around using HRT after breast cancer is old and limited, but women should be helped to understand how it relates to them. Your decision may not always align with your healthcare professional’s opinion but this should be respected if you have had a full and frank discussion about the risks and benefits.

• That said, HRT is absolutely NOT the wonder drug it is often portrayed as. As a team we find that women who can’t use it can and do manage their menopause brilliantly using a whole range of other options.  Given the right support and advice this multilayered approach can work wonders.

For further information contact the Norfolk Menopause team or Starthrowers. Breast Cancer Now and Danni Binnington’s Menopause and Cancer podcast are also highly recommended.

www.norfolkmenopause.co.uk