Breast Cancer & Menopause FAQs

Q1: What products can most breast cancer survivors currently get at Alloy:

• Vaginal Estrogen: Vaginal estradiol cream is FDA approved for the prevention and treatment of the genitourinary syndrome of menopause. For breast cancer survivors dealing with menopause from any cause, including premature menopause from surgery, chemotherapy, ovarian suppression or aromatase inhibitors, vaginal estrogen is an option. It is low dose and absorbed in the local tissues of the vagina, vulva, urethra and bladder and is not systemically absorbed. As always, a NAMS trained menopause specialist will review your particular medical history and decide if this is a good choice for you.
• Paroxetine:Paroxetine is an FDA approved option for treating hot flashes. Paroxetine is an SSRI used to treat depression and anxiety disorders at higher doses. The dose of paroxetine used to treat hot flashes is much lower than therapeutic doses needed for depression and has been found in clinical studies to help with hot flashes, night sweats, and in turn helping with the insomnia that they cause. It may help with anxiety as well. Note that if you are taking Tamoxifen, you should not take Paroxetine because of a drug interaction. Talk to your doctor about other options if you are on Tamoxifen. See the NAMS (North American Menopause Society) most recent position statement on non-hormonal options.
• O-mazing: Alloy's O-mazing cream is a prescription blend of sex-enhancing clinical ingredients. It contains Sildenafil (commonly known as the brand name Viagra) which for women increases blood flow, stimulates natural lubrication, and heightens physical sensations leading to a stronger, more fulfilling orgasm. It also includes Pentoxifylline and Ergoloid mesylate which work synergistically to increase blood flow and stimulate neurotransmitters associated with sexual pleasure. The ingredients are only absorbed in the local genital tissue and there is no systemic absorption. It is great for women with decreased sexual arousal and libido looking to enhance their sexual response. You may find that treating the genitourinary syndrome of menopause symptoms - like vaginal dryness, decreased sensation and arousal, painful sex, bladder and urinary symptoms - are all greatly improved with locally applied vaginal estrogen. You can use O-mazing cream regardless - but by improving the tissue you may find it works better and that you have a better overall sexual experience once the tissue is properly estrogenized.
• M4: A hydrating anti-aging face cream with 0.3% Estriol (plant based, bio-identical estrogen) for facial rejuvenation. It improves the appearance and health of facial skin by boosting the development of underlying collagen structure, increasing elasticity and skin moisture, and reducing wrinkles. This is a low dose of topical estriol and is not associated with any increase in circulating levels of estrogen. As always, a NAMS trained menopause specialist will review your particular medical history and decide if this is a good choice for you.

Q2: Does Alloy prescribe systemic hormone therapy to breast cancer survivors?

Currently at Alloy we do not routinely prescribe systemic menopausal hormone therapy (i.e estradiol pills or patches) or birth control pills to women with a history of invasive breast cancer. We can prescribe vaginal estrogen. Breast cancer survivors need an in depth review of their cancer history and specific diagnosis, and more lengthy and detailed discussion of benefits, risks and alternatives of systemic hormone therapy. This often involves a review of her medical records, and coordination with her health care team. We hope to be able to offer more consultation and care options in the future.

Q3: I carry a BRCA 1 or 2 or other genetic mutation and/or I have a high risk family history for breast cancer, but I have not had breast cancer. Can I be prescribed hormone therapy?

Yes! MHT does not increase your risk of breast cancer over your baseline risk. In studies of women using estrogen-only MHT, they had a decrease in breast cancer risk by 30%. Use of estradiol along with micronized progesterone (rather than a synthetic progestin) is neutral or slightly lowers your risk. The duration of therapy does not increase your risk. In the case of the WHI study, when women used synthetic estrogen plus synthetic progestin, the attributable risk of MHT to breast cancer was less than one additional case of breast cancer per 1,000 users annually. That risk is only slightly greater than observed with one daily glass of wine and similar to risk of obesity and low physical activity. In the WHI study, the women who used estrogen only (those without a uterus) had a 30% DECREASE risk on the 20 year follow-up. The modern MHT we use now is FDA-approved bioidentical estradiol and progesterone for most patients . A preponderance of evidence suggests that hormone therapy use does not further increase the relative risk of breast cancer in women with a family history of breast cancer, in women after oophorectomy for BRCA1 or 2 genetic variants, or in women having undergone a benign breast biopsy. Women with high-risk breast cancer family history or other high-risk factors for breast cancer should not be denied MHT to treat symptoms. Regular breast cancer screening is advised for all postmenopausal women per current guidelines and we always encourage women to do breast self-checks and get a yearly clinical breast check by a healthcare provider. At Alloy, a NAMS trained menopause specialist will review your particular medical history and help you decide if hormone therapy is a good choice for you.

Additional Reading: Dr. Sharon Malone's Blog Post on Breast Cancer Risk | NAMS: Use of Systemic Hormone Therapy in BRCA Mutation Carriers

Q4: I am on Tamoxifen and have a lot of genitourinary symptoms of menopause. Can I use vaginal estrogen?

Yes, vaginal estrogen can safely be used by breast cancer survivors. NAMS, ACOG and ASCO all have professional guidelines on usage.

Breast Cancer Survivorship Tips

Bone Health

Make sure you know about your bone health and ask if you are a candidate for a bone density test. Speak with your team about the effects of your medications on bone health and ask if you are at risk for osteoporosis. It is very important to make sure you are eating a nutritious diet with plenty of calcium in your food, and consider taking a Vitamin D supplement.

Cardiovascular Health

Most breast cancer survivors will survive their disease and it is important to remember that heart disease, not breast cancer, is the leading killer of women. Breast cancer survivors who experience premature menopause for any reason are at a further increased risk of heart diseases. Speak to your health care team about your personal cardiovascular risk and know your numbers! This means your cholesterol levels and other lipids, fasting glucose, blood pressure, BMI, and ask about other tests like EKG, Coronary Artery Calcium Score, and more. You can also do your own risk asessment here. Remember that women have gender specific cardiac risk factors, and breast cancer treatments can add to the risk, so speak to your health care team.

Menopause, Weight and Nutrition

Menopause is a challenging time for most women when it comes to managing their weight. The premature loss of estrogen and the impact of cancer treatments and stress can make it much worse. For an excellent review of how women can nourish their body, help support it metabolically in menopause, watch this webinar Alloy did with Dr. Mary Claire Haver from The Galveston Diet.

Sexual Health

Menopause and the changes in hormones, and the resulting symptoms can really impact a woman’s sexual function. Cancer treatments and premature or surgical menopause can add to the problem. Learn more above about how vaginal estrogen or O-mazing can help you. Breast cancer survivors deserve to have their sexual health concerns taken seriously. Low desire, arousal and orgasm problems, pelvic pain, sexual pain, clitoral adhesions, and genitourinary changes all impact cancer survivors more and there are solutions to help you. Also see excellent resources at the patient education site of ISSWSH and we also recommend checking out the Rosy App which has excellent breast cancer survivorship sexual health resources.

Menopause Health

Menopause symptoms are not just bothersome, they can greatly impact your quality of life, and are associated with significant preventative health and chronic disease concerns. All women should have access to solutions to treat your menopause symptoms. Breast cancer survivors should speak to their healthcare team about all the available data on the benefits versus risks of both hormonal and non-hormonal treatment options.