Menopause Care and Quality of Life in Breast Cancer Survivors

Alexandria, VA – In a milestone decision, the U.S. Food and Drug Administration (FDA) announced November 10 that it is recommending the removal of black-box warnings, the agency’s highest warning for prescription medications, from all hormone therapies used to treat symptoms from menopause and perimenopause.

“This is a huge win for women,” said Adrian Thompson, a local physician assistant specializing in women’s healthcare. “This finally allows for more open, informed conversations about hormone therapy. Breast cancer survivorship is about so much more than just surviving,” she added. “It’s about quality of life.”

Even as up to 90 percent of these survivors develop sexual health problems, however, often due to treatment-induced menopause, most are told that estrogen and other hormone treatments are never an option, she said.

“So many of these patients are becoming cancer-free these days, but then they really struggle with things like libido, joint pains, pain with sex, hot flashes, and night sweats. I have women who tell me they haven’t had sex in years because it feels like shards of glass,” Thompson continued.

“Many are simply unaware that we have a whole new universe of safe and inexpensive, FDA-approved topical vaginal hormones that treat only vaginal and bladder tissues and don’t increase their overall hormone levels, and we also have FDA-approved non-hormonal options.”

“They simply feel like themselves again.”

The bottom line? After modern hormone treatments, “so many patients tell me they simply feel like themselves again, and that is so deeply rewarding.”

How did Thompson become so confident on this issue? It didn’t happen overnight. She was already a Certified Menopause Society Provider, yet when the first breast cancer survivor came to her asking about hormones, Thompson recalled, “I gracefully referred her to an appropriate clinician and began a new phase of advanced education and certification focused on menopause in breast cancer survivors and ‘previvors’—women at higher genetic risk for developing breast cancer.”

She completed “Managing Menopause After Breast Cancer with Confidence,” a course led by Dr. Corinne Menn, a board-certified OB/GYN and nationally recognized expert in menopause and breast cancer survivorship.

The 2002 Women’s Health Initiative — and What We Know Now

Concerns over hormone therapy safety date back to 2002, said Thompson, when the Women’s Health Initiative (WHI) suggested that combined estrogen and progestin therapy increased the risk of breast cancer and stroke. Those early headlines fueled decades of fear—but later reviews revealed a far more nuanced story.

“Follow-up studies showed the data were largely misinterpreted,” said Thompson. “Women in the estrogen-only arm actually had a 24 percent lower risk of breast cancer, while the tiny increase in the combined group wasn’t statistically significant—and there was no rise in breast cancer deaths. Both groups saw fewer hip fractures, less diabetes, and those within 10 years of menopause had decreased risk of cardiovascular disease.”

Even more encouraging, she noted, the WHI studied women using oral estrogen, which passes through the liver and can increase clotting risk. “Today, we use transdermal estrogen—patches, gels, sprays, or rings—that bypass the liver and are far safer for most women.”

The Bottom Line? Patient Education

“Education is so important,” said Thompson, who emphasized the importance of working with your own healthcare providers to “understand what you’re being prescribed, what your risk is, and what your options are. Go through every option and work together to figure out what’s best for you—and always, especially when dealing with cancer, consider a second opinion.”