In this interview segment, JJ Virgin asks an expert to outline options for managing menopause symptoms in breast cancer survivors who are hormone‑receptor‑positive and therefore cannot use systemic hormone therapy. The question sets the stage for a discussion of evidence‑based, non‑hormonal interventions covering hot flashes, sleep disturbances, vaginal dryness, and overall quality‑of‑life strategies tailored to this high‑risk population.
Someone coming in who is a breast cancer survivor who is hormone receptor positive, what are some of the things that they can do for all the menopause symptoms then if they can't use hormones?
I'm so glad you asked me that because the big—
I hope you have something really good.
The big thing is I want people to hear that no one should suffer. I think a lot of cancer survivors get told, be thankful you're alive. We've got all these wonderful treatments. Uh, we will keep you alive and just deal with the side effects of treatments. And that just isn't true. So certainly when someone is going through active treatment, that's not a time where we would have these conversations about the use of hormones. What I do like when people are candidates for hormone therapies is I like to think of it as It's sort of a blanket treatment that can treat many different symptoms. The temperature dysregulation, the mood changes, the sleep dysfunction, the vaginal dryness, the sexual dysfunction, the joint pain. When someone has breast cancer and is going through treatment and you can't do a blanket treatment like that, you need to target the individual symptoms. So when it comes to hot flashes, we have many other alternatives. There are prescription drugs, low doses of a number of different medications, antidepressants, neuropathic pain relievers, overactive bladder medicines, a whole slew anti-seizure medicines, whole slew of medications that in low doses can treat hot flashes. We also have a new category of drugs. First drug that we understand the mechanism of how hot flashes occur and where it targets. It's a drug called fezlinatant. The trade name is Vioza, and it targets what's called the candy neurons in the hypothalamus in the brain, which is where temperature dysregulation occurs. And so that's just another tool in the toolbox of different drug options that are available to, to target the temperature dysregulation. Then we target sleep because if you're not sleeping, there's lots of data that says you don't exercise as well, you don't make healthy food choices, you're just not gonna feel as well. So there are plenty of supplements that can be used for sleep. Magnesium glycinate, lavender, which can be helpful for sleep-related anxiety, L-theanine, ashwagandha. We try to figure out, do people have trouble falling asleep or staying asleep? We know the incidence of sleep apnea goes up after menopause. We send people for sleep studies. We do a deep dive focusing in on their diet, what they're eating, when they're eating. We talk to people about timed eating, which can help improve sleep and helps decrease hot flashes at night. So there are many, many different things we can target into vaginal dryness and sexual dysfunction. And even when someone is on these antihormonal therapies like aromatase inhibitors, they can still use certain types of vaginal estrogen. So we can treat that, which, uh, there are treatment options for sexual dysfunction. So virtually every symptom that women come in with, uh, in the perimenopause and menopause that cancer survivors also have, we have treatment options that are available. They may not be as successful sometimes as the overriding HRT, but there are many, many treatments that can be given.
