Many kinds of breast cancer are hormone-sensitive, meaning that they grow faster in the presence of estrogen and/or progesterone, which are naturally produced in the female body until menopause. When your cancer falls into this category, part of the aim of chemo (and the Tamoxifen I’ll be taking later) is to stop the body’s production of estrogen and progesterone. This means that you go into menopause, at whatever age you happen to be.

I had been in perimenopause (ie, on the way to menopause) for years. It’s  no fun. Symptoms include migraines, ferocious mood swings, insomnia, and hot flashes. Many women take hormone replacement therapy (HRT), which alleviates these symptoms by partially replacing the hormones that your body is no longer producing. I started HRT about five years ago.

My doctors took me off all hormones as soon as the cancer diagnosis was confirmed in November. Analysis of the biopsy material soon showed this to have been the right decision: my tumor was both estrogen- and progesterone-sensitive. Hormone-sensitivity is good news for treatment: you can slow the growth of the tumor and any other cancer cells in the body, and reduce the likelihood of recurrence, by not having these hormones in you.

But this means that, in addition to the direct side effects of chemo, I am dealing with all the symptoms of menopause. Many of the side effects listed for chemo would occur during a natural menopause anyway, but I guess they are considered side effects of chemo because chemo causes menopause at any age. The completion of menopause also means that a woman can no longer get pregnant; that’s why infertility is often a side effect of chemo (though, in younger women, it’s not always permanent).

Because I now have a history of hormone-sensitive cancer, I will never again have hormonal options to deal with the menopause. I can’t take “natural” alternatives, either – if a substance, regardless of origin, has the same effects as estrogen on my body, it could have the same tumor-stimulating effects on any cancer left in my body as well.

So I’m now dealing with menopause the old-fashioned way: suffering through it. Very frequent hot flashes mean I can’t stay comfortably dressed for more than a few minutes at a time – whatever I’m wearing one moment will be too hot or too cool the next. The human head dissipates heat quickly, so my first reaction to a hot flash is to take off whatever head covering I’m wearing. I am well past being embarrassed over showing my lack of hair.

I’m also having mood swings, though it’s hard to be sure how much of this I’d be having anyway. Cancer and the treatments for cancer, and then living with the possibility of recurrence, are all emotionally very hard: I think I have a right to some moods!

Insomnia… ugh. The only time in my life that I have been a sound sleeper was the third trimester of pregnancy. Both chemo and menopause contribute to insomnia, in my case it’s so bad that, even with ambien, I wake up multiple times a night for one reason or another. On the worst nights, between waking up a lot and turbulent dreams, I get up in the morning feeling that I’ve barely slept.

On the up side: I haven’t had any migraines recently, and I haven’t had a period since I stopped the HRT in November. My gynecologist did a blood test and found that I’m still producing enough hormones that I could possibly still ovulate and be fertile. I suppose the Tamoxifen will put an end to that – that’s what it’s meant to do.

HRT and Breast Cancer Risk

Research on the possible role of HRT as a cause of cancer has gone up, down, and sideways during my lifetime. When I started taking HRT, the current thinking that I was aware of (and was reported by the gynecologist who prescribed it) seemed to be that HRT did not significantly increase the risk of cancer, and that there were possible beneficial effects on brain function later in life for women who took HRT through menopause and beyond. source

I have recently learned that: ”In 2000, the so-called Million Women Study in the United Kingdom identified estrogen and progesterone, prescribed in hormone-replacement therapy to women to ease menopausal symptoms, as major risk factors for the incidence and fatality from estrogen-positive breast cancer.” [Mukherjee, Siddhartha The Emperor of All Maladies: A Biography of Cancer (2010-11-16).  (p. 456). Scribner. Kindle Edition.]

Investigating further, it appears that the form of HRT I was using (estrogen only), is not nearly as risky as the estrogen-progesterone form that I would have been given after I stopped having periods: “Current use of HRT is associated with an increased risk of incident and fatal breast cancer; the effect is substantially greater for oestrogen-progestagen combinations than for other types of HRT.” source

So… I guess I don’t have to feel like I caused my own breast cancer by taking HRT. I did think that for a while. It was not a helpful addition to the emotional load of cancer.

my breast cancer story (thus far)

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