Are you struggling to cope with the menopausal side effects of breast cancer treatment? Do you lie awake at night tossing and turning as the sweat pours off your body? Maybe you wish there was something you could take when HRT is off the table? On this episode I’m going to answer all your questions about breast cancer treatment and the menopause with this week’s guest, Professor Annice Mukherjee. She’s a consultant endocrinologist, and the author of ‘The Complete Guide to the Menopause.’
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You can get a copy of Annice’s book ‘The Complete Guide to the Menopause: Your Toolkit to Take Control and Achieve Life-Long Health’ here (https://www.amazon.co.uk/gp/product/1785043293?tag=prhmarketing2552-21) or in all good bookshops.
You can also follow Annice on X (Twitter) (https://twitter.com/AnniceMukherjee) and Instagram (https://www.instagram.com/the.hormone.doc/) .
The MSK research we mentioned about supplements is here (https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs) .
And here (https://thebms.org.uk/education/principles-practice-of-menopause-care/bms-ppmc-resources-toolkit/what-are-the-alternative-treatment-options-to-hrt/) is where you can find British Menopause Society guidance about HRT and how to treat menopause.
The new medication I mentioned from the US – Flibanserin – has a write up here (https://www.sciencedirect.com/science/article/abs/pii/S1743609522013418#:~:text=It%20is%20feasible%20for%20women,improved%20patients) if you want to learn more about it.
And the amazing Maggies has some menopause advice here (https://www.maggies.org/cancer-support/managing-symptoms-and-side-effects/menopause-and-cancer/) .
If you want to read more of Donna Ashworth’s poems, her new book ‘Wild Hope’ is available in all online bookstores. You can find out more about Donna on her website (https://donnaashworth.com) , or follow her on Instagram (https://www.instagram.com/donnaashworthwords/) and Facebook (https://www.facebook.com/donnaashworthwords/?locale=en_GB) .
If you’ve got a question for me, then please get in touch online or send me a voice note. You can find me on social media (see below), or e-mail me at hello@oriordan.co.uk .
If you want to find out more about breast cancer whilst you’re waiting for the next episode to drop, you can watch the videos on my YouTube Channel (https://www.youtube.com/channel/UC_t0jGeR8M4vCPSb68itjRQ) or read my book ‘The Complete Guide to Breast Cancer: How to Feel Empowered and Take Control.’
If you’re nosey and want to find out more about my life, my memoir ‘Under The Knife’ – is available in all good bookshops.
You can follow me on social media for regular updates – Instagram (https://www.instagram.com/oriordanliz/) , Twitter (https://twitter.com/Liz_ORiordan) and Facebook (https://www.facebook.com/profile.php?id=61552316873196) .
Finally, if you loved the show and want to help other women like you find it, you can leave a 5-star review wherever you get your podcasts, or you can show your support to help keep the show going and buy me a coffee here (https://www.buymeacoffee.com/lizoriordan) .
Are you struggling to cope with the menopausal side effects of breast cancer treatment or do you lie awake at night like me tossing and turning as the sweat pours off your body maybe you wish there was something you could take when HRT is off the table well today I’m going to
Answer all your questions about breast cancer treatment and the menopause with this week’s guest Professor anise Muki she’s a consultant endocrinologist a menopause specialist and the author of the complete guide to the menopause This is so now I’ve got breast cancer the podcast for anyone who’s just been diagnosed I’m Dr lizo Ren the breast surgeon with breast cancer and I found out the hard way just how little I knew when I suddenly found myself in the chemo chair it’s why I wrote my book the
Complete guide to breast cancer there’s a lot of bad information out there and I want to guide you down the right path so if you’ve got a question this show will answer it for you now I’m going to let you into a confession when I worked as a breast
Surgeon I never told my patients how to handle the menopausal symptoms that were coming their way and then I got breast cancer and chemo threw me into an instant menopause I thought I’d wet myself when I had my first night sweat and I get so many questions about how to
Cope and that’s why I had to get today’s guest Professor anise Muki to help me answer them she’s a consultant endrocrinologist which means she’s an expert on anything to do with hormones and Women’s Health and she’s had years of experience helping women with breast cancer just like you and if that’s not
Enough she’s also one of us because anise has had breast cancer herself welcome to the show thank you for having me great to be here oh it’s a pleasure to have you we’re going to talk and talk and talk today but before we get into the nitty-gritty could you tell us a bit
About your own experience of breast cancer and the menopause okay so in 2011 I was a consultant endocrinologist at suil hospital in the NHS and I’d worked many years before that for many years at Christy Hospital Hospital which is a cancer hospital I’d looked after many women who had gone through a breast
Cancer diagnosis and I had a particular interest in helping women through a difficult experience after breast cancer and the consequences of treatment for breast cancer including menopause so that was my gig that’s what I did in my career I also did lots of other hormone related problems but I had a particular
Interest in what we call late effects which is the the hormone effects after cancer treatment and yeah and and in 2011 never ever thinking anything like that would happen to me because none of us do I found a lump in my breast and I went to the breast surgeon and who was a
Colleague of mine at Salford and she said I’m 99.9% sure this is going to be nothing I was 41 years old no family history very fit and well and it was cancer and then you know as we all go through that early Journey which is incredibly hard because there’s so many
Unexpected things happening they were going to do do my surgery they had the date booked then when I went for a further ultrasound to look at my lymph nodes they found a second cancer so the surgery had to be canceled and rescheduled and I had to have major surgery and more
Investigations I you know went through the Journey that I’d you know managed so many patients going through and cared for so many patients and nothing prepares you for that that diagnosis nothing we all know that and then after I had my treatment they said oh it’s it’s early stage it’s early stage you
Don’t need any more treatment and as an endocrinologist as a hormone specialist I I was really fearful cuz I had estrogen positive breast cancer and I was more frightened of recurrence which I think many women aren’t now because we’re so good at curing cancer but breast cancer can come back many years
Later I was really fearful of having estrogen around and I wasn’t fearful of menopause because I’d helped so many women through that and they ended up giving me chemical blocking therapy to put push me into early menopause so I went through menopause then and I wasn’t fearful because I had so
Much knowledge and that was why I wrote my book because I wanted to try and help women understand that if you understand if you have applied knowledge and you understand what you’re going through and you know the strategies you can use it’s less traumatic it’s less difficult and
That’s for menopause during a cancer diagnosis and you know menopause for many women who aren’t going through a cancer diagnosis which can be difficult and I wish I’d read your book when I was diagnosed because I was clueless but for anyone listening can can you explain why the chemotherapy and the hormone
Blockers make us menopausal well chemotherapy is a toxic treatment it’s trying to kill cancer cells but it often damages other things in the body it damages all fast growing cells and obviously you lose your hair and things like that but chemotherapy is very toxic to the ovaries so in women
Even younger women much younger women going through chemotherapy often their periods will stop but when you’re much younger sometimes the periods come back but if you’re sort of in your 40s and your body was heading towards per menopause anyway chemotherapy is often that straw that breaks the camels back
And it stops the OV is working all together and that’s part I mean that’s also thought to be part of why it’s so effective for breast cancer because it’s killing the cancer cells but it’s also blocking the source of estrogen which feeds cancer cells chemical therapy
Which is what I had which the sort of zodex treatment is a chemical treatment that shuts the ovaries down so it kind of works in a in a similar way to chemo on the ovaries but it’s not toxic elsewhere so chemical menopause on its own without chemo isn’t as bad as chemo
I didn’t go through chemo because I wasn’t deemed you know the right stage the therapy and then there is obviously medications that we use after the initial cancer treatment like tamoxifen and Aromas intis and they block any last semblance of estrogen so T oxen blocks estrogen in breast cells and breast
Cancer cells so many women say they develop menopause symptoms with tamoxifen and aromatase Inhibitors are just taking away every last bit of estrogen around your body yeah yeah and it’s a real wake up cool when it happens to you now I’ve got a voice note here
From CLA who sent this into to us my question is if you are on hormone treatment and you don’t actually have a huge amount of menopausal symptoms does that mean that you have loads of estrogen still kicking about in your body it’s a concern of mine so I I was
Just wondering about that so I presume Claire means when she says hormone therapy she means hormone blocking therapy like to moxen or aromatase Inhibitors yet it’s a great question because there’s a lot of talk about the severity of symptoms and side effects with you know chemotherapy to moxen causing manopause symptoms and many
Women do get really unpleasant effects probably up to 30% of women who are pushed into menopause through treatment will get severe symptoms but actually that means means maybe up to 70% of women will get some symptoms but not severely and I think I was probably in
In a similar catgory to CL I didn’t have no symptoms but I got some sweats and flushes I got sleep disturbance I got the brain fog which goes in that it’s classic in that you know early menopause phase so I got those symptoms but I was
Sort of similar to I thought I’m not feeling ill enough I should be feeling iller but it’s because everybody experiences menopause differently it’s a really unique experience and if you’re going through menopause during a cancer diagnosis the stress around that cancer diagnosis can cause a lot of the
Symptoms so if you’re being supported well and you’re you feel in control and you know maybe a bit of luck here and there as well you don’t get severe hot sweats and flushes then no not everybody gets severe symptoms and it absolutely does not mean that the treatments aren’t
Working it just it’s just you know sort of luck of the draw sort it’s just one of those things it may be that cla’s doing loads of things right in terms of her lifestyle and well-being that are helping her you know stay calm and not be too stressed stress is a horrible
Thing when you’ve got cancer diagnosis and menopause at the same time because it’s it’s really difficult not to feel overwhelmed and stressed and then the menold symptoms reproduce that and we’re going to come on to that but let’s start with what are the typical side effects that a woman going through a cancer
Menopause might experience well the classic men pause symptoms that are tightly linked with the drop in estrogen are the vasomotor symptoms and by that I mean the hot sweats flushes night sweats feeling you know that heat coming through I used to describe it like a reverse orgasm you
Know feel it rising up the body and you don’t want it but you know it’s coming yeah absolutely and then changes in the periods obviously so you know some women might you know have a No period some women will have a sudden torrential bleed and then the vaginal symptoms
Which are tightly linked with that drop in estrogen so not every woman gets those either but it can be dryness soreness pain you know discomfort water infections so those symptoms are very tightly linked with the drop in estrogen and we do have treatments that can help
With all of those even if you can’t have HRT and then there are a lot of symptoms that overlap with the fact that you’re going through a cancer diagnosis or the stress of life in general so of course if you’re having terrible hot sweats at night that impacts your sleep and it can
Make you feel fatigued and it can make you feel anxious and overwhelmed it can make you hungrier during the day crave carbs so they can be indirectly linked with those hot sweats and blushes but of course you know feeling exhausted tired all the time is something that many
Adults men and women of all ages can get sleep disturbance fatigue overwhelm anxiety depression they’re not specific to menopause and of course if you’re going through a cancer diagnosis that’s a major life event so those those symptoms might be related to your change in hormones but they may also be related
To everything around that the overwhelming situation you’re in I’d never thought about that so everything that you may blame on the menopause could just be due to the fact that you’re dealing with a cancer diagnosis you’ve had treatment you’re juggling a family and a job and um I guess changes
In our lifestyle might be factoring it as well yeah absolutely absolutely yeah so I mean obviously those symptoms can be due to other things they may be due to menopause and it’s quite helpful just understand that some symptoms link tightly with menopause but you might have some symptoms you’re blaming on
Menopause that aren’t menopause you know they they may be linked to other things and yeah lifestyle is interesting because for the whole of society lifestyle is more adverse today than it was 20 30 40 years ago midlife women are highly much more likely to be employed
So they’ve got you know a job which adds stress but there’s lots of other things there’s care roles for elderly relatives there’s you know less time for exercise because we’re all so busy we’re using phone devices everything that comes through devices on the phone every piece
Of news you see it’s all bad it’s all stressed we’re more sedentary our diets are not as good I’m afraid across the board because even food that is marketed as healthy is often very unhealthy so our lifestyles start to deteriorate from adulthood all the way through our adult
Life and then it kind of gets to that point where you then go into menopause and you can’t get away with those sort of unhealthy lifestyle habits anymore we blame everything on menopause when actually we’ve been building up problems like weight gain gradual weight gain over 20 years lack of physical activity
You know poor sleep habits which then when as soon as you your estrogen drops that can make your sleep worse so it’s kind of a combination of not just lifestyle at that point suddenly when you hit 45 or 50 or go through a cancer diagnosis but it’s something we’ve been
Building over our whole adult life so before we even think about talking about drugs to help it’s looking at your lifestyle thinking can you sleep better sleep hygiene better diet exercising just to help everything really yeah and and I completely know that a lot of people when you mention lifestyle
Particularly in the middle of a cancer diagnosis they’ll roll their eyes up because they’ll go are you kidding me you want me to start building up my exercise when I’m feeling exhausted so that there are barriers to that and what I would say is you know when you get
Diagnosed with cancer thank goodness the vast majority of women going through breast cancer Will Survive it now which it wasn’t the case 40 years ago so what we need to think is look at the long game and look at tiny changes because tiny steps every day add up over months
And years to you feeling better your health being better you’re reducing your risk of recurrence because lifestyle approaches are proven to do that as well so it’s really about thinking about lifestyle as a long game and just being aware of it not beating yourself up and
Thinking I’m going to start going to the gym when you’re exhausted but just being aware that that it’s going to make a difference we all want a miracle cure for symptoms and I think the thing about well we’ll talk about HRT but HRT is is being promoted inappropriately as a
Miracle cure on social media and it isn’t a miracle cure because I see women the commonest reason for women seeing me in my clinics are ongoing symptoms despite HRT and that’s why I’m so hyperaware because those women get better when I address the other things
In their life you know and and so I think if you’re going through a cancer diagnosis you think but I can’t have the miracal Cure because I want HRT and I’m being told I can’t have it and that would make me feel better and in some
Ways you can always get a placebo effect if you try it because you think this isn’t going to be an amazing treatment and you feel relief of being empowered by being able to have it but it’s a false economy because actually a lot of women then say Well it it worked for a
While and now it’s not working and that’s a placeit effect and it it doesn’t cure all of those other things it won’t cure poor sleep hygiene it won’t cure chronic stress it won’t make you lose weight if you’ve got 20 years of gradual weight gain that it’s tough
But lifestyle is important and I I cannot I can’t not emphasize that it’s like that 1% rule just make be 1% better every day with it’s micro doing your lifestyle tiny tiny changes that can help it’s a bit like you know you take us people take statins most people have
Heard of statins and people are given statins if they’ve got very high cholesterol high risk of heart disease and it’s a preventative treatment but actually lifestyle is a preventative treatment with no risk it’s not a tablet it’s free most of the time yeah but moving on to some of the symptoms Emma
Karen and Louise are all struggling with joint pain and feeling like they’re a 100 years old is anything that can help with that part of the menopause so again there’s lots of different things every single woman is different in the cause of her pain so if you’re on AR romaas and hippitus they
Will generally increase aches and pains so if it’s absolutely unbearable then it’s sometimes worth having a chat with with your cancer doctors your cancer team to see if you can either have a drug holiday or a switch to tamoxifen if that’s possible because although Aroma Inhibitors are preferred if the symptoms
Are so awful that your you know your quality of life is is seriously impaired it worth discussing that with your cancer team if the aches and pains are you know not related to the aromati Inhibitors or any other treatment often again you know you go through cancer treatment you’re not moving very much
Because especially with chemotherapy you know it depletes you it’s so paradoxical the less we move the more we ache as we get older and the people with the least aches and pains are the people with the strongest muscles because as your muscles get weaker they get filled with
Scar tissue basically we call it disuse atrophy but it’s it’s it’s muscles being infiltrated with scar tissue so then when you move the muscles find it harder so again building up movement in again micro doing is really helpful not necessarily exercise if you’re in severe pain but just small movements stretching
Sit to stand walking around the room or going outside for for a bit of fresh air and stretching anything is better than nothing but don’t try and do loads just make tiny changes every single day and that makes a difference and then if you’ve got a lot of pain there are
Medications that can be used to help with pain management also things like cognitive behavioral therapy type approaches I know it sounds strange but they these work for lots of physical illnesses including pain type problems so it’s sort of holistic really the management of pain and sometimes tweaks
In medication can help but almost always doing nothing makes it worse and Tiny movements does not make it worse but over time will help and I found that too you get so stiff and sore if you’re not moving but now on to one of the bins of
My life hot flushes and night sweats gr asked us if they’ll ever go away can we get rid of them are there any drugs that can actually help yeah so about 80% of women will get them but for about 25 to 30% of women will get them severely so
It’s like drenching it’s like you say you think you’re wet yourself it’s just a complete sweat everywhere and and it can be really disabling day and night and so for those women who need treatment there are things available so there’s lots of little lifestyle hacks that you can do you know wearing thin
Cotton clothing in layers don’t wear turtlenecks wear soort of keep your upper chest clear I know that sounds obvious but sometimes you don’t think you put a nice outfit on and then you’re absolutely overheating and once the sweat starts very disabling keeping your room temperature cool some people like
Carrying fans around you know these are little little tiny tweaks that you can do that just reduce the severity when it when they actually occur at work desk fans or air conditioning all sorts of different things you can use avoiding hot drinks and spicy food because they
Bring on on sweats um cold showers there’s lots of data on cold water immersion helping with um menopause symptoms including the heat sensitivity symptoms so a cold shower at night is a thought if you get a lot of night sweats it can cool your body right down so
That’s the Practical things that you can do for yourself and there are quite a lot of different things and then there are medications there’s lots of medications that can be used to help with those hot sweats and flushes so the choice of medication will kind of depend on you what specific signature of
Symptoms you have and what other medication you’re on because tamoxifen can interact with some other medications that we use for sweats and flushes after a press Gant diagnosis so Vena vacine is one of the drugs in very low dose it’s actually a type of anti-depressant it works on noradrenaline and serotonin in
The brain and in a non-antidepressant dose in a very very tiny dose it can really reduce hot sweats and flushes and it’s been proven in research studies in women with breast cancer but it also reduces anxiety and and can help with sleep so if it works for you it’s great
I have patients some of them love it some hate it and there’s a whole load of other medications from oxybutinin which is a blad treatment so if you if you need to go to the toilet a lot and you you’re having urgency it also reduces sweats so that’s fits for some women and
Some women love it and some say I I tried that and it’s awful the same I gave a talk the other day and I mentioned clonidine I’ve had that to be honest it can cause your blood pressure to drop it can make you feel dizzy it
Can make you feel tired so it’s not for everybody kodine is a bit like Mite but for my patients who have high blood pressure and it’s good for migraines clonidine as well so if you’ve got migraines high blood pressure sweats it it fits really well in very low dose for
Some people not in high dose so there’s lots of different treatments and of course if the listeners are thinking well I’ve tried that and it didn’t work that’s why we have a whole range of treatments and of course we’ve got a brand new treatment which is now licensed in America it’s called
Fezolinetant and it is targeting the menopause symptom mechanism in the brain it’s incredible it’s a first inclass I’ve never seen any development like it in my 30 plus year career it’s being looked at by night at the moment um going to be really expensive so it’s
Going to be a while but to have home I think is brilliant because it works for hot sweats and flushes quicker than HRT does and it helps with sleep energy mood and even weight balance so it’s got some incredible effects and it it’s minimal inside effects it’s a tablet treatment
So you know that is a game Cher and I’ve seen all the data and the data look incredible and because of the the way it works we don’t foresee that it’s going to suddenly have side effects we’ve got 52- we data very clear data already from all the research studies so that is
Really hopeful for the future for any woman who’s struggling and who’s trying different things and they’re not a great fit because that will be available you know in the near future wow that is amazing we’ll we’ll put details about that in the show notes but you mentioned
Mood and Tony sent us this voice note my question is about mood swings and irritability during menopause I notice that sometimes my mood can be a little erratic I snap at my husband I’m irritated with my family at times and I find that it’s something Beyond normal everyday
Frustration is there anything I can do to help me deal with that I feel I’m becoming a different person during menopause especially after having undergone gone treatment for stage 2 ER positive breast cancer thank you yeah and I’m sure many of the listeners will really relate because in
Midlife all of us are under a lot of pressure and I don’t apologize for bringing the p word up because pressure is there for everybody but for women in midlife more than for anyone else I’m afraid today because we are more overcommitted than any other generation no matter what anyone say
People will say well 30 years ago women didn’t have the washing machines and the car you know but actually women are under more pressure today and I know that I see women you know in my clinics I can’t believe what women do and what
They take on and you know men take on a lot men have always taken on the work and everything but now women have got the work and all the home stuff so the pressure then the menapause then a cancer diagnosis and what I see again and again are two things in relation to
The symptom the mood swings that your listener was talking about overc commitment so there’s no downtime and lack of self-compassion so when you do lose your rag you then self- loathe and you feel awful and so the mood swings are very frequent I think across the board and when you’ve had a cancer
Diagnosis you know that’s different again if you apply some self-compassion and some self-care and sounds so nebulous but if you just give yourself a little bit of self-care you won’t be as irritable you just won’t everything will be better and people then say to me I don’t want to be
Selfish I don’t I’ve got to look after everybody else and I say that’s exactly the reason you need self-care because you can only look after everyone else if you’re looking after yourself especially when you’re going through the cancer diagnosis and all of that now of course if it’s severe and you mental health
Issues are escalating across the board in our modern society because of the pressure that everybody’s under and many other things as well that there are medications and if you’re I think there’s a real stigma about sort of anti-depressant type medication in that I see you know women going well I don’t
Want to be given anti-depressants because I’m not depressed it’s it’s my midlife my my menopause my cancer diagnosis but if you could take a treatment and it lessened those symptoms and it made you kind of feel less guilty to just look after yourself a bit it could be transformational you’re not weak you
Take an anti-depressant you you’re trying to sort your health out and certainly as I mentioned Vana vaccine but there are other very low dose anti-depressants that you can use that they’re not really a strong they’re not going to make you feel numb they’re not not in low doses they’re just going to
Kind of make you feel a little bit calmer and maybe a bit of more objective and and more productive actually because you’ll feel better so I’m not saying everyone needs anti-depressants I think everyone everyone listening needs to apply more self-care more self self compassion also exercise gives you the
Euphoria so movement exercise doing something that you enjoy gives you the endorphins and that is a great mood regulator because it’s helping with the stress this feeds into the lifestyle eating better helps with your mood moving more outside fresh air mindfulness approaches CBT can be really
Helpful for your mood so not quick fixes but nothing is a quick fix really things can sound like a quick fix but all those strategies are going to help it’s not a one- siiz bits all and you need to kind of find what works for you really the
Lesson I’m hearing is we need to be kinder to ourself I mean for goodness sake we’ve had cancer we need to give ourselves a break and I’ve been on anti-depressants for years because cancer can cause depression and anxiety that can kick in years down the line and
There is nothing wrong in having them and they won’t keep me going but a couple of my followers have talked about something else which is really hard the menopause and the drugs cause hair thinning and and hair loss and it can be really distressing when you’re young is
There anything we can do to help with that or prevent it well obviously if women who are going through chemotherapy are likely to lose their hair even if they have a cold cap they’re going to get the net there’s not a lot of really high quality research data on this so
The caveat here is I’m going to be giving you my personal clinical experience advice rather than saying this trial showed this and that trial showed that because there are medications that can be used for hair loss but generally speaking we them early on after a cancer diagnosis so a
Few things stress makes hair loss worse so again that goes back into the self-care self-compassion reducing the stress doing the exercise that’s all quite important to actually help with the hair cycle because you need micronutrients certain micronutrients are very important for the healthy hair growth things like zinc selenium iron
Some of the B vitamin so Biotin for example they’re very important and if you’re going through cancer treatment if you’re exhausted and if you’re stressed you don’t necessarily absorb those micronutrients as efficiently as you would do if you were otherwise fitting well so if you’ve got less of those and
You’re under stress and you know you’re going through menopause and the menopause hormone changes can cause hair loss Cycles as well taking a supplement with vitamins and minerals in it and and you know sometime you can just go and get the hair and nail one from boots or
Tesco because they have the biotin zinc selenium iron if you think might be anemic you might need prescription iron because obviously if you’re having heavy periods or you’ve gone through chemo and and you’re anemic that can all make things worse hair loss during that phase is usually time limited through the
Menopause transition some women you know after they’ve gone through menopause will say my hair is not as thick as it was when I was in my 20s some women have amazing hair and it’s amazing all their life and some women will notice slightly thinner hair as they get older anyway
And it can be a little bit abruptly worse after the menopause transition but what doesn’t happen is you just don’t get thinner and thinner and thinner and then go Bal like that’s not how it works total alpia is different and stress makes hair loss worse so I’ve seen many
Women through my career in my clinics where they haven’t had a hormone problem and they’ve come specifically regarding hair thinning and is it hormonal and the stress of seeing that hair in in the B plug when you’ve washed your hair and you know I’ve had women bringing the
Hair in saying look how much I’m losing that creates huge amounts of stress and that stress triggers it so understanding it’s not going to go on forever there are things you can do but the hair cycle is several months so whatever you do now you won’t see any rewards for six to n
Months and if your hair is falling out now it’s what happened 6 n 12 months ago that’s apart from chemo obviously yeah that’s really helpful thank you we mentioned supplements and I think most cancer patients should take a general multivitamin tablet because we don’t eat well ger and cancer your taste changes
Really really hard but I’ve had a lot of women tell me to take Sage or black Goos or jinsang all these things they’ seen online and um we had a voice note come in from Joanne about this I’d like to ask what sort of Remedies or supplements
Can you take for menopause I can’t seem to find a chemist that will commit to confirming whether or not any of the ones that are out there contain hormones things like menopace Etc so advice on what we can take to reduce hot flushes Etc would be massively appreciated
Thanks so there’s a double question there isn’t there because there as said about well-being energy hair nails skin you want to make sure your micronutrients are optimized but then the second bit of that question is supplements for hot sweats and flushes black poos red clover you know the phy
Oans you know the answer to this as well as I do probably better Liz because I know you research it very recently so you can add but what I would say is I wouldn’t take anything really without speaking to the cancer team because a lot of those CHS we just don’t really
Know what’s in them and some of them definitely contain some sort of hormonally active things like the phytoestrogens so you you need to be very very cautious I am a big advocate of sort of an a tozed vitamin and mineral so if you if you’ve got a
Supplement that you can look at the ingredients and if it’s literally just got your 20 plus vitamins and minerals that are essential you can’t make those in your body so you have to get them from food and if you’re not eating a balanced diet and no you shouldn’t be
Beaten up by not wanting to eat a balanced diet when you’re go through chemo or you’re stressed you know but you do need to make sure you’re getting those essential minerals and vitamins in so you know if you if you’re concerned speak your cancer team and Liz Can can
Add to this but I think the standard a to zed that haven’t got the added query ingredient some of them have added ingredients so if it says over 50 or women ‘s Health you just got to be a bit careful the standard a to zed should just be vitamins with minerals and I’m
I’m quite an advocate of those for General energy well-being yeah and I would say your cancer team probably haven’t heard of half the menopausal supplements that are now being sold at the moment because we don’t use them we don’t take them we honestly don’t know
And a lot of them will say ask your a doctor there’s a caveat is it going to be bad for your health the thing with tamoxifen is there are some supplements that can interact with it and stop it working like black cohos like St John’s
Wart so I think you need to be really really careful and you have to do your homework and I’ll put a link to a website in the description from msk which is really good at checking if something interacts with the tablets you on but if you’re having a multivitamin
And a good diet you really shouldn’t need them yeah and I would add black hush can also cause liver problems and yeah St John’s W interacts with a lot of medication so I wouldn’t I would really ster clear of anything like that certainly in the first phase of of all
Your canc treatment and always speak to your your doctor yeah yeah now we’ve talked a bit about HRT and anise and I have talked a lot about this off air if you believe everything you read online then HRT is a Savor for every woman going through the menopause and it stops
You dying from dementia and osteoporosis and I’ve had a lot of angry scared women like you listening in the breast cancer Community terrified we’re going to die of a heart attack because we’re not having HRT and our lives are going to be over and I think it’s important that
People with breast cancer understand why they can’t have HRT and what it can and can’t do can you touch on that a bit for us well no International reputable impartial menopause Society recommends HRT after breast cancer diagnosis and that includes estrogen triple negative breast cancer because those cancers can
Still come back as an estrogen positive cancer or you can get a second primary that can be positive so that is the the guidance and that’s based on a lot of scrutiny of all the research data in a balanced way looking at all the data now over the last couple of years there
Has been a huge amount of social media influencing with completely contradictory opinions that I’ve looked and scrutinized as Liz has at justification for saying actually it’s probably fine to take HRT after breast cancer and it’s all flawed it’s all conflicted and it doesn’t add up and I
Have got 30 plus years of experience I’ve got an ending I’ve done loads of research I can scrutinize research studies if I believed I was going to be better off from a heart to’s osteoporosis dementia perspective with HRT you know I would take it I I’ve had early stage breast cancer actually you
Know I I if I thought it was going to prevent me having diseases I would take it I’m the best person to advise the people online who are suggesting it’s safe have got significantly less credentials than Liz and me right and we’re not out of date we are literally
Scrutinizing everything in the here and now as are all the other experts the thing is this whole commentary about HRT being safe is just well that’s just flawed and then the commentary that HRT prevents dementia heart disease and whatever else it’s guesswork because we don’t have those data at all in fact
Some of the data well most of the data is either new or it suggests an increased risk of Dementia in people receiving HRT and I think there was one study that was highly flawed from America that said oh bioidentical HRT reduces risk of dementia that was in a
Group of women who were highly selected who had zero risk of heart disease and heart disease is the biggest predictor of dementia risk and it wasn’t actually published in a peer-reviewed very good Journal because it wasn’t quality we talk about peerreview because to get into a good Journal it has to be high
Quality and it was just fled it was meaningless actually but it’s being promoted on social media and unfortunately women looking at social media believe it because it looks like glossy ad almost a glossy headline this will prevent de it’s absolute nonsense that HRT prevents dementia all we know
Is nothing we know nothing but what we do know I’ll go back to this and I don’t apologize lifestyle exercise good whole food diet social NW work Stress Management good sleep quality all of those are absolutely proven to reduce dementia risk and heart disease and heart disease yeah and osteoporosis you
Know the whole shebang you know so but again oh you you want to take a pill to prevent a disease because it’s easy getting your trainers on and actually cooking your own food and I understand that but it doesn’t do what we’re being told it does it’s fake news it’s
Misinformation at its worst it’s it’s disinformation really and there are many women who are going on HRT who don’t have risk factors for the wrong reasons and you know those women may be some of the women in the next 10 20 years who some of those may come to harm from
Going on HLT for the wrong reasons HLT is a helpful treatment for menopause symptoms if it’s safe but for many women I treat with HRT it’s not a miracle cure I really cannot emphasize that more in a way I’m privileged to see that every single day in my clinic I see women who
Have tried six0 different types of HRT and they’re not feeling better so this whole nons and I you know I see thousands of women and and I’m not in some private Clinic with a brand that’s trying to promote a private treatment I’m in the real world it’s kind of
Coldface and so it’s not a miracle cure so first of all it’s not a miracle cure second of all it’s not safe if you’ve had a breast cancer diagnosis the only caveat to that vaginal estrogen is often okay it’s not the same as systemic HRT and there’s quite a lot of
Accumulating data on vaginal estrogen after breast cancer treatment because those are symptoms that are very bothersome for many women and you need to discuss it with your cancer team but the cancer teams that I work with at the Christie Hospital are generally very happy for patients to have vaginal
Estrogen yeah and that’s so we’re talking about systemic HRT vaginal estrogen we know it’s safe to give a women on tamoxifen we think it’s safe to give to women on Aromas Inhibitors and I’m going to do a whole episode on that later a Year’s worth of vagital estrogen is the
Same as one HRT tablet and I think that is a complete Game Changer and everyone should be allowed to have it and I think HRT can be used as a very very last resort if women are really really struggling particularly with their mental health and they’ve tried all the
Other things dose reduction they’ve had a treatment break if needed but it’s not safe because if your cancer is sensitive to enogen that means esen gets your breast cancer cells to grow and even though it’s been removed and you’ve had all the treatments there can be breast cancer cells floating around the body
Just sitting there and that bit of easen that you’re getting from HRT could make them wake up start to find a friend and grow because breast cancer can come back 20 or 30 years in the future and that’s why we don’t think it makes sense to give
HLT I hope we put that one to bed for now anything else you want to say on that well I was going to say I see many women in my clinics who have had breast cancer who’ve been struggling who want to discuss whether or not HRT
Would be helpful for them and I would tell you that in the you know 99.9% of cases we will discuss treatment options and we will find treatment options that work without HRT and I also see women coming to see me who have been given HRT by other clinics or you know
Who’ve been given it relatively flippantly being told it’s probably fine and then they’re concerned and actually the majority of patients say well I thought it helped a bit at the beginning but it’s not really made a difference the thing is you can feel empowered because you’re given a treatment you
Think is going to be a miracle cure so you can feel a relief initially but it’s not safe it has to be a really detailed discussion to make sure you are aware of the risks down the line and whether you’re willing to take those risks and
If it’s really worth it and if if you’ve explored all the other options and generally speaking the answer is generally no yeah it’s not safe and we don’t recommend it I think the problem at the moment is that I’m seeing and I mean some of your listeners might relate
To this is that they are being it’s like a hard cell you will be fine don’t worry it’s absolutely safe and they’re not counseled properly we call it informed consent and we’re not collecting the data are we and there’s no data collection so it will take us decades to
See an increased recurrence rate but I know my oncology colleagues across the country are getting lots of women saying I know that HRT is safe why why don’t you let me have it and it’s misinformation and so if you’re being fed misinformation that isn’t informed consent you’re not being given all the
Facts great advice there now I could talk to you for hours and hours and hours and I’m sure we’re going to have to get you back but my one takea away from this is self-care and be kind to myself and I will tell my husband I’ve
Been told no I’m not going to cook your dinner tonight and he said I’m going to go and have a bath and read a book have you got three little tips you could give our listeners just to help them cope when life does get really hard well that’s number one self-care self-
Kindness self-compassion so a bit of down time even if it’s 5 minutes you know here and there very very powerful for well-being stress relief the second tip is that this storm is temporary you know going through a cancer diagnosis and cancer treatment is is a very tough gig and again that feeds
Into why you need to be so kind to yourself because not everyone has to go through that and it is is a really tough gig so it’s temporary it’s a big deal for you it’s a big deal for your mind for your body once the treatment is over
That storm subsides and you will get your life back at some point and that’s it’s really important to understand that there is light at the end of that tunnel and then thirdly and I don’t apologize for saying this because I say all the time and I think everyone’s
Rolling their eyes up at me is that lifestyle hacks are an investment in your future your future health your future symptoms reducing your cancer recurrence you know well-being results don’t work overnight it’s a long game but you will reap the reward just tiny tiny changes in the right direction continuously you know you
Don’t need to climb the mountain all at once just a few steps here and there and in six months 12 months 18 months you’ll be in a different place brilliant I can’t wait to hear what you’re all doing to change your lifestyle today and thank you so much anise for coming on the
Podcast my Pleasure that was Professor anise mcki and I have to thank anise for sharing her breast cancer story with us and it’s been so refreshing to hear that there are lots of things we can do to help with the menopausal symptoms and that most of them don’t involve swallowing another
Tablet I know how little time surgeons and oncologists have to tell you how to cope and I wish everyone being started on hormon blockers could listen to what anise had to say thank you so much for all your questions we’ve had so many and I’m really sorry if I could and get
Yours in if you found this episode useful make sure you share it with everyone you know who could do with hearing it too and I also want to give a shout out to Maggie centers who have just started running menopause workshops to help you cope I think the take-home message for
Me is that it does come down to Lifestyle and as anise said making those tiny changes on a daily basis to how we eat sleep and exercise will make a huge difference down the road to our quality of life and I know it’s hard to do but but I really think we’re worth
It and now it’s time for our poem of the week from Donna Ashworth our podcast poet if you haven’t come across Donna yet her brilliant new book Wild hope is full of inspiration and joy and today’s poem is no exception and on we go there is much power in the phrase and
On we go we break and rebuild knowing we will break again we lose but we still love though we know that pain won’t end we struggle along alone yet we stop along the way to help another stand to see a brighter day no matter what we have faced in this
Life no matter how hard we have smashed against the Rocks we wash up we shed tears we wail to the skies we let go we rest we brush down we shake off and on we go I always start to smile when I hear Donna read to me and that was on we go
From her new book Wild hope if you want to read more of Donna’s poems or find out more about Dr anise mcki and her brilliant book The Complete Guide to the menopause or send me a question for the you’ll find all the details in the show notes next week I’ll be talking about
How important exercis is after a breast cancer diagnosis with one of the world’s leading experts Professor Katherine schmidtz from the University of Pittsburgh what can I do to increase the likelihood that I come to the other side of this as whole as I am right now and
One of the most powerful things that anyone could do in that stretch of time between the diagnosis and the first treatment is a strong program of exercise I’m Dr Lisa Ren thanks for listening and I’ll see you next Week so now I’ve got breast cancer is produced by birdline media