I’m been on Letrozole for 6/7 months which reduces all the oestrogen in your whole body. I had been on HRT systemic and vaginal for years before bc and had to come off it all last April. A few weeks later symptoms started to raise their ugly head.
I had surgery in July 2023, chemo with Herceptin (on this until Sept 2024) from September, radiotherapy in January the started the Letrozole. I was bi lateral invasive cancer, two primary tumours, one each in boob.
Chemo side effects took over most of the menopausal symptoms but by January I was feeling awful again. In Nov 23 there was a study about vaginal oestrogen with Tamoxifen/letrozole/Anastrozole and results suggested no impact on mortality. Vaginal oestrogen was available on Tamoxifen and some were moved off Letrozole to Tamoxifen to be able to vaginal oestrogen. This study suggested it was ok with Letrozole/Anastrazole as well. See link below.
My menopausal symptoms were achy joints, helped by walking, stretching, a monthly massage and gentle exercise. Hot flushes were horrendous, mainly from 7pm to 7 am, so I changed the time I took the Letrozole, moved 1 hour earlier to 5pm from bedtime, then changed to 12 noon, then 8 am, not change in the hot flushes. It woke me up every time before the flush happened, then id struggle to get back to sleep. I could be woken up from 3-7 times a night, suffice to say I was knackered with such poor sleep. I tried a sleeping tablet, Zopliclone but it didn’t stop me waking up.
The vaginal atrophy was getting worse aswell, to the point I couldn’t sit on an exercise bike, I had hoped to get fitter. Repeated soreness and UTIs. I had used Yes moisturiser and lubricant (NHS prescription) as well as trying Sutil lubricant ( which is richer in texture, bought from jodivine website).
I asked my breast care nurse what could be done and was referred to a menopause specialist via the NHS in February, but 4 months on I was still waiting and I was getting worse. I found out that the same consultant could be seen privately, I booked it Friday and saw them on Monday. I was prescribed Fezolinetant (veoza) for the hot flushes on a private prescription to try for one month. It has reduced the hot flushes significantly, study suggest 50-70% improvement. It is a non hormonal drug, hopefully should be on the NHS by January 2025.
I was also offered Oxybutynin which is available on the NHS, there are several anti depressants and other drugs that treat hot flushes , see here Menopause - Treatment - NHS I decided on the above. You can also have a variety of anti depressants but they were suitable for me due to tachycardia (fast heart rate), as the medicines can cause this.
They also wrote to my GP to prescribe Imvaggis and Blissel, very low dose vaginal oestrogen, 3 weeks on I can feel a massive difference. We discussed the risks and benefits of taking vaginal HRT and that after 6 weeks they is no sign of it in your blood stream. Within the first 6 weeks some oestrogen can pass through but it’s still a very low dose. This was checked through blood tests in studies. We discussed my Predict score https://breast.predict.cam/ and they have written to my consultant. This was to decide if my % was low whether I could come of Letrozole, for me being bi lateral with two separate primary tumours, I would prefer to stay on it with help with side effects. The consultant said they have ladies who have come of their hormone blockers, some who take systemic HRT and some like me, it’s an individual choice and risk. I will hopefully now see them in the NHS clinic for my follow up.
I would also suggest looking at www.menopauseandcancer.co.uk , Dani Binnington has had her own diagnosis and talks to many experts to get help with symptoms. There is a podcast with an oncologist which I found very interesting.
www.maggies.org do a menopause session. I attended one in Velindre, Cardiff after I’d seen the menopause specialist and still found it very helpful.
Dr Liz O’Riordan also has information on her social media/youtube.
I looked into ‘natural’ help but many are not tested or regulated like medicines are. Many things like Black Cohosh are not recommended for those with a bc diagnosis. If you were considering herbs etc please look at
MSKCC which will look at interactions with your medicines. This was discussed at the Maggie’s course.
I hope this helps others experiencing similar issues
I think I’ll contact the GP to discuss that low oestrogen option.