Having Breast Cancer was never my choice.

Mindful living and understanding helped me live healthier and more positive.

Being diagnosed with Breast Cancer is devastating. Countless thoughts will run through your mind.

What now? What next?

Before you have time to accept and process your diagnosis, you will be thrust into the realm of treatment.

The staging of cancer determines the treatment plan. Below are the five main ​treatment modalities that can be used in combination to treat Breast Cancer.

Surgery

● Mastectomy: complete excision of the affected breast followed by breast reconstruction surgery

● Lumpectomy: removal of only the affected part of the breast tissue (is also known as breast-conserving surgery)

Chemotherapy


These drugs kill abnormally multiplying cells. This is the reason why individuals on chemotherapy experience vomiting or hair loss because these drugs also kill normal rapidly dividing cells. Chemotherapy can be used before or after surgery.

Hormonal Therapy


Some types of Breast Cancer respond to hormones. That is the cancer tissue grows in the presence of estrogen and/or progesterone (receptor-positive). Hormonal therapy counteracts the production and action of said hormones.

● Tamoxifen: prevents the action of estrogen on the breast tissue

● Aromatase inhibitors:prevents the conversion of androgens to estrogen

Biological Therapy


Consists of exogenous antibodies which will work with the body’s immune system to fight cancer cells. Commonly used alongside chemotherapy.

Radiation Therapy


Using high-energy rays (similar to X-rays) to kill the cancer cells. It is often used before or after surgery.

How does breast cancer treatment affect your menstrual health?

All these treatments have their own set of side effects, however, one of the most impactful changes that can occur with these treatments is to your menstrual health.

Approximately 60-80%of women on chemotherapy experienced a complete cessation of the menstrual cycle (amenorrhea) or irregular cycles (oligomenorrhea).
The ovaries contain rapidly dividing cells, this means that they are likely to be affected by ​chemotherapy.​ Suppression of the ovaries by chemotherapy will cause ovarian dysfunction leading to temporary amenorrhea, oligomenorrhea,and/or early menopause.

However, certain drugs can be used to protect the ovaries during chemotherapy treatment. ​GnRH​ agonists are often prescribed to protect the ovaries from the harmful effects of chemotherapy. Hormonal therapy​ also induces amenorrhea and/or oligomenorrhea. The decrease in estrogen will also cause hot flashes, vaginal dryness, mood changes, decrease in libido, loss of bone leading to bone and muscle pain.

Tamoxifen​is a selective estrogen receptor modulator (SERM). This means that in some tissues, it has a negative action (prevents the growth of tissue) and in some tissues, it has a positive effect (promotes the growth of tissue). In the breast tissue, it has a negative effect, hence why Tamoxifen is used in breast cancer treatment. However, in the endometrial lining of the uterus, it has a positive effect. Tamoxifen induces the growth of the endometrial lining and increases the risk of endometrial cancer.

The L​evonorgestrel Intrauterine System​ (LNG-IUS) is a progestogen-containing contraceptive placed within the uterine cavity. It releases a small concentration of levonorgestrel and inhibits the growth of the endometrial tissue. The use of this contraceptive device alongside Tamoxifen therapy is known to reduce the growth of endometrial tissue and decrease the risk of endometrial cancer.

Certain antidepressants, such as Selective Norepinephrine Reuptake Inhibitor(S​ NRIs)​ are known to reduce hot flashes and can be used during hormone therapy. Bone loss can be prevented by the intake of calcium,vitamin D supplements, and certain medications.

What can you do about it?

Juggling various facets of Breast Cancer treatment can be overwhelming and tiring, and menstrual health and hygiene are often overlooked in this scenario.

In some women, Breast Cancer treatment can lead to premature menopause. But in most women, these changes to the menstrual cycle are temporary.

Regular menstrual cycles commonly ​resume​ within 2 years after completing the treatment course. In older women, it may take longer for menses to resume, and will likely be irregular.

During breast cancer treatment, one can opt for GnRH agonists to protect the ovaries or LNG-IUS, to protect the endometrial tissue.

But how else can you take care of your menstrual health during treatment?

> Keep track of your cycles and menstrual flow.

You may or may not experience menstrual changes during treatment, but keeping track of it will help you identify any small changes.

> Take care of your body and mind
It is a challenging time. Breast cancer treatment can be physically and emotionally taxing. Consider doing low-intensity exercises, such as yoga or walking/jogging. A study​ found that practicing meditation and yoga improved the quality of life and fatigue amongst breast cancer patients. And don’t forget about your hobbies! Continue doing what you love to do.

> Take care of your gut
Food and menstrual health are interlinked. An unhealthy diet can affect your menstrual health. So, consume healthy balanced meals, if any changes in your cycles occur, you will know for sure that it wasn’t because of your diet! Also,you will need all the vitamins and minerals to stay strong during treatment.

> Be aware of any mood changes
Being diagnosed and treated for breast cancer treatment in it is emotionally exhausting. Everyone copes distinctly. Besides this fact, one of the side effects of treatment is mood changes. You may also notice changes in your Premenstrual Syndrome (PMS) symptoms. So keep track of these changes, this maybe in form of a diary or journal.

Every woman has her way of coping with this diagnosis and treatment. Reach out to other women who have or had breast cancer. Ask them about how they took care of their body and menstrual health during this time. Read their stories and share your experience. Looking after your menstrual health may be the first step to better overall health management. But know that.. You Are Strong, Courageous, And Not Alone!

References

1) Leonard RCF, Adamson DJA, Bertelli G, MansiJ, Yellowlees A, Dunlop J, Thomas GA, Coleman RE, Anderson RA; Anglo CelticCollaborative Oncology Group and National Cancer Research Institute Trialists.GnRH agonist for protection against ovarian toxicity during chemotherapy forearly breast cancer: the Anglo Celtic Group OPTION trial. Ann Oncol. 2017 Aug1;28(8):1811-1816. DOI: 10.1093/annonc/mdx184. PMID: 28472240.

2) Dizaye, Kawa. (2016). Menstrual and Hormonal Changes inBreast Cancer Patients Treated By Ad-juvant, Adriamycin, and CyclophosphamideChemotherapy.

3) Sporn MB, Lippman SM. Agents for Chemoprevention and TheirMechanism of Action. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors.Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003.Available from: https://www.ncbi.nlm.nih.gov/books/NBK12522/

4) Dominick, S., Hickey, M., Chin, J., & Su, H. I.(2015). Levonorgestrel intrauterine systemforendometrialprotectioninwomenwithbreastcanceronadjuvanttamoxifen.TheCochrane database of systematic reviews​, ​2015​(12), CD007245.https://doi.org/10.1002/14651858.CD007245.pub3

5) Jacobson, M. H., Mertens, A. C., Spencer, J. B.,Manatunga, A. K., & Howards, P. P. (2016). Menses resumption after cancertreatment-induced amenorrhea occurs early or not at all. ​Fertility andsterility,​ 105​(3), 765–772.e4.https://doi.org/10.1016/j.fertnstert.2015.11.020

6) Greenlee, H., DuPont-Reyes, M. J., Balneaves, L. G.,Carlson, L. E., Cohen, M. R., Deng, G., Johnson, J. A., Mumber, M., Seely, D.,Zick, S. M., Boyce, L. M., & Tripathy, D. (2017). Clinical practiceguidelines on the evidence-based use of integrative therapies during and afterbreast cancer treatment. ​CA: a cancer journal for clinicians,67​(3),194–232. https://doi.org/10.3322/caac.21397

7)  Kaplan, M., Mahon, S., Cope, D., Keating, E., Hill, S.,& Jacobson, M. (2011). Putting Evidence Into Practice. ​Clinical journalof oncology nursing,​ 15​(2).

8)  McDonald ES, Clark AS, Tchou J, Zhang P, Freedman GM. ClinicalDiagnosis and Management of Breast Cancer. J Nucl Med. 2016 Feb;57 Suppl1:9S-16S. DOI: 10.2967/jnumed.115.157834. PMID: 26834110.

9) Drăgănescu M,Carmocan C. Hormone Therapy in Breast Cancer. Chirurgia (Bucur). 2017Jul-Aug;112(4):413-417. doi: 10.21614/chirurgia.112.4.413. PMID: 28862117.