In diagnosing and treating breast cancer, health care providers must make it a cardinal goal to provide a full spectrum of support to women.
Along every step of their journey—from the moment of screening, to treatment and beyond—women need to know they have access to the resources and experts who can provide critical help.
This support should continue in the months and years following treatment, ensuring women don’t suffer preventable side effects.
Some treatments, for example, can lead to bladder problems that cause distress.
At the Spectrum Health High Risk Breast Cancer clinic, we often help women facing such symptoms.
Breast cancer care begins with awareness, emphasizing the importance of early detection and mammograms.
It continues well beyond that, of course, helping women understand what cancer survivorship means and showing them how to deal with health concerns that arise beyond treatment.
Some treatments can trigger menopause, for example, and medications can lead to low levels of estrogen in the blood.
Women will then face symptoms of menopause or low estrogen, which can involve hot flashes, night sweats, mood changes, sleep disturbance, low sex drive and vaginal dryness. This can lead to pain with intercourse, bladder urgency and leaking.
These symptoms create a vicious cycle, causing poor sleep, irritability and brain fog.
Vaginal and bladder symptoms can be distressing and disruptive to sleep. No woman wants to get up in the middle of the night and rush to the bathroom, risking a fall and injury.
And yet, more than 50% of women experience significant symptoms from menopause.
We want women to know they are not alone. We want them to know these problems can be remedied.
There’s even a medical name for these types of symptoms: genitourinary syndrome of menopause.
It can involve vulvovaginal itching or dryness, painful intercourse, bladder urgency, leaking or recurrent bladder infections related to low estrogen.
There’s been a recent push to teach health care providers about the many options available to screen and treat these problems.
Medical societies have worked together to come up with accepted guidelines—a critical component in establishing treatments.
These options must take into consideration a vast array of factors, such as the risk of breast cancer recurrence, the amount of trouble the symptoms are causing, the effect of prior treatments and the woman’s own personal preferences.
The first step: Talk about the symptoms. It’s important we all take this on.
Women deserve answers.
Health care providers need to at least acknowledge the problems and refer the patient to a specialist if the issue is outside the doctor’s comfort zone.
Women sometimes experience unnecessary suffering because they fear treatment, or there’s simply a lack of knowledge about the options.
At the Spectrum Health Midlife, Menopause and Sexual Health clinic, we ask everyone who comes through our door about these symptoms.
A thorough review
We recently had one patient—we’ll call her Mary, for privacy—who explained how her menopause symptoms were causing her a great deal of trouble.
“I’m up all night to empty my bladder,” she said. She suffered itching, too, and found she could rarely make it to the bathroom in time.
When I asked her for more information, she explained how she felt terrible pain with intercourse, to the point it made it impossible.
She thought her symptoms were just part of aging.
She figured she had to deal with it, even though it got much worse after her treatment for breast cancer and while on her current oral medication.
We then began to review Mary’s experiences in greater detail, developing a deeper understanding of the extent to which each symptom bothered her.
We gauged her daily habits, such as water and caffeine consumption, and took stock of her medications and other issues. We talked about the type of cancer she had and the likelihood of recurrence. We talked about her fitness level and bone health.
We then did a physical exam.
We found low estrogen effect in the vagina and surrounding tissues, including the bladder opening and tight pelvic muscles.
Given her bladder urgency, I checked a urine test for infection, which she did have.
Mary felt relieved to learn there were treatable causes of her symptoms, even though she had not been looking forward to the pelvic exam.
The first step involved treating her bladder infection. We also talked early on about how to prevent more infections from happening.
She had restricted water throughout most of her day, while also drinking about two to three cups of coffee.
Adjustments to those types of habits could help tremendously.
Coffee is acidic and irritating and, without water, it can cause bladder urgency.
Understandably, Mary had concerns that drinking more water would keep her in the bathroom. I explained that, even after a short period of several days of more urination, the body tissues can soak up the water and lead to more energy, less urgency and overall feeling better.
We also talked about introducing probiotics into her diet, such as kefir or kombucha.
There isn’t consistent data about whether this helps all women reduce the chance of vaginal and bladder infections, but it’s still helpful to encourage healthy bacteria in the gut by consuming these items and a high-fiber diet.
We discussed non-hormone options first, as these are often effective for mild symptoms. These options include vaginal moisturizers—in the pH range of 4—that contain no additives such as parabens or glycerin.
Moisturizers such as Hyalogyn, which contains hyaluronic acid, can be very effective.
Lubricants are all different and the decision should hinge on individual preference.
While some women have no problem using oils such as coconut oil or olive oil, others may only see their vaginal infections worsen with such products.
Ultimately, treatment for genitourinary syndrome of menopause has to be individualized.
This is especially true for women with a low risk of recurrence, with breast cancer negative for estrogen receptors or with distressing symptoms that lead to poor quality of life, local vaginal estrogen can be considered.
Several products are covered by most insurance.
For women interested in local vaginal estrogen, doctors recommend bioidentical estrogen, which is FDA-approved.
Some products have more safety data than others, so it’s important to know the risks related to estrogen getting into the blood via contact with vaginal skin.
The doses are low, however, and aren’t thought to be a risk for getting into the blood. Consequently, it’s not considered a significant factor in increasing the risk of cancer recurrence.
We also have to recognize that local vaginal estrogen can significantly increase quality of life. This treatment has been shown to reduce bladder infection frequency, reduce urgency, treat dryness and reduce pain with intercourse.
Mary had Stage I breast cancer. She took tamoxifen, an estrogen-blocking medication.
The symptoms significantly affected her life.
After she tried the moisturizers and lubricants without much relief, she chose a low-dose vaginal estrogen insert. This brought her great relief.
Mary’s oncologist showed great support for the plan and was glad she tried other options first. Best of all, we were able to discuss with Mary the pros and cons of these treatments.
The bottom line: Suffering is unnecessary—and help is always available.