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Menopause and Cancer

January 04, 2021
  • 00:00Support for Yale Cancer Answers comes
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  • 00:14Welcome to Yale Cancer Answers with
  • 00:17your host doctor Anees Chagpar.
  • 00:19Yale Cancer Answers features the
  • 00:21latest information on cancer care by
  • 00:23welcoming oncologists and specialists
  • 00:24who are on the forefront of the
  • 00:27battle to fight cancer. This week
  • 00:29it's a conversation about menopause and
  • 00:31cancer with Doctor Mary Jane Minkin.
  • 00:33Doctor Minkin is the Co-director
  • 00:35of the Sexuality Intimacy and
  • 00:36Menopause Clinic at Smilow Cancer
  • 00:38Hospital and Doctor Chagpar
  • 00:40is a professor of surgical oncology
  • 00:42at the Yale School of Medicine.
  • 00:46Mary Jane, maybe we can start
  • 00:48off by kind of setting the scene.
  • 00:50How often is menopause
  • 00:52and menopausal symptoms
  • 00:54an issue for cancer survivors?
  • 00:57Are there particular cancers that
  • 00:59really cause these menopausal symptoms?
  • 01:02I can think of at least two, breast and
  • 01:06ovarian that may really have an impact here,
  • 01:10but can you speak a little bit about how
  • 01:15common it is to go into menopause?
  • 01:19Either with the treatment of these
  • 01:22cancers, or
  • 01:23just as a result of surgery
  • 01:29or chemotherapy.
  • 01:30You bring up all of the
  • 01:33right situations and certainly
  • 01:34breast and ovarian are the classics,
  • 01:37but even something like, for example
  • 01:39a rectal cancer.
  • 01:40When I think of a hormonal issue
  • 01:43that if a woman gets radiation therapy
  • 01:45to her area for pelvis that ends
  • 01:48up radiating her ovaries as well,
  • 01:50that can put her into menopause.
  • 01:52And then of course she's dealing
  • 01:54with radiation affects to her pelvis
  • 01:56which can impact vaginal function.
  • 01:58Things of that nature.
  • 01:59Certainly you bring up the
  • 02:01issues that certainly surgery, if you
  • 02:03take out the ovaries can lead one into menopause
  • 02:06even if she's premenopausal, radiation
  • 02:08therapy to the pelvis can do it.
  • 02:10And many chemotherapeutics can do
  • 02:12that by stopping ovarian function,
  • 02:13at least temporarily, if not permanently.
  • 02:15There are times when a woman
  • 02:17will get some chemotherapy and her
  • 02:19ovarian function will come back.
  • 02:21Particularly if she's younger,
  • 02:22but sometimes it doesn't.
  • 02:23But the good news is,
  • 02:25even though menopause can be brought
  • 02:27about by all of these situations,
  • 02:29there are good news on two fronts.
  • 02:31First of all,
  • 02:32if somebody is going to be having
  • 02:34chemo that may impair her own
  • 02:36ovarian function and she still wants
  • 02:38to have kids we can actually now
  • 02:41save eggs before she undergoes the
  • 02:43therapy for fertility preservation.
  • 02:45And we can actually freeze these
  • 02:47eggs when she's ready to use them
  • 02:49so that we can preserve fertility.
  • 02:52And indeed,
  • 02:52even if a woman gets chemotherapy that
  • 02:54knocks out her ovarian function and
  • 02:56renders her menopausal that we can
  • 02:59often give her estrogen replacement therapy.
  • 03:01There are some cancers where of course
  • 03:03we can't, particularly breast cancer.
  • 03:05However,
  • 03:06there are many, many cancers
  • 03:08in which estrogen therapy is just fine.
  • 03:11So for example,
  • 03:11if a woman had lymphoma or even
  • 03:14somebody who has had a stem cell transplant,
  • 03:17something like that,
  • 03:18estrogen is quite
  • 03:19fine in those circumstances.
  • 03:21So we can restore her and
  • 03:23save her from menopausal symptoms,
  • 03:24lots of options.
  • 03:27Let's talk a little bit about all of
  • 03:29those things because I think you
  • 03:31bring up so many great topics.
  • 03:33The first is you know,
  • 03:35especially for premenopausal women,
  • 03:37the idea of fertility is so important,
  • 03:39but it's something that they
  • 03:41really need to be talking to their
  • 03:44doctors ahead of time to deal with.
  • 03:46Is that right?
  • 03:47The answer is absolutely yes,
  • 03:49and we do encourage young women to
  • 03:51speak to their oncologist about saving
  • 03:53eggs before undergoing chemotherapy,
  • 03:55and many people are panicked.
  • 04:00They hear the diagnosis, cancer and
  • 04:02think, I've gotta get therapy tomorrow.
  • 04:03And indeed you want to get therapy promptly,
  • 04:06but tomorrow you don't need it.
  • 04:08And we usually have time with most
  • 04:10cancers to basically do a cycle
  • 04:12or two and get a lot of eggs that
  • 04:15can be preserved,
  • 04:17so she doesn't have to have
  • 04:18her chemotherapy or radiation
  • 04:20therapy immediately.
  • 04:21We can get those eggs,
  • 04:22so it is something that's really
  • 04:24important to talk about before
  • 04:25they start chemotherapy
  • 04:26or radiation therapy.
  • 04:28And in those patients I
  • 04:31mean fertility issues aside,
  • 04:32I can just imagine that
  • 04:35being tossed into menopause
  • 04:36like that as a result
  • 04:38of your treatment when you're
  • 04:40premenopausal beforehand can be
  • 04:43rather problematic for patients.
  • 04:45Can you talk about the
  • 04:47difference between a surgical
  • 04:50menopause versus a natural menopause?
  • 04:52Because some people who
  • 04:54may be listening may think
  • 04:56you go through menopause,
  • 04:58you're going to get there someday?
  • 05:01Why not
  • 05:01as a result of your treatment?
  • 05:03You're absolutely right,
  • 05:04and indeed with a natural menopause,
  • 05:06the ovaries, and the term I use
  • 05:08is poop out,
  • 05:09because that's what they do,
  • 05:10but it's a gradual process for most
  • 05:12people and the transitional phase
  • 05:14we refer to as perimenopause.
  • 05:16Those are the years leading up
  • 05:18to that final menstrual period,
  • 05:19and the year thereafter.
  • 05:20And that can take several years.
  • 05:22And it's a gradual decline of
  • 05:24ovarian function so that it's
  • 05:26not like one day you have a lot
  • 05:28of estrogen on board and one day you don't
  • 05:31which is indeed what happens
  • 05:32with a surgical menopause, or
  • 05:34if somebody gets a radiation therapy or
  • 05:35a big blast of chemotherapy initially,
  • 05:38it can be quite disruptive
  • 05:40to your hormonal function and the
  • 05:41symptoms are usually more pronounced
  • 05:43with them or abrupt change.
  • 05:45And of course the other issue is that
  • 05:47our estrogen levels decline over the
  • 05:49course of time even before menopause.
  • 05:51For example a 20 or 25 year old
  • 05:53has a lot more estrogen hanging
  • 05:55around than somebody who's 45,
  • 05:57even though she's not menopausal at 45,
  • 05:59so the declines are going on gradually
  • 06:01as we get older over the course of
  • 06:04time and our bodies are getting used to it.
  • 06:07So an abrupt change can be quite disruptive.
  • 06:10However, again,
  • 06:10there are many situations.
  • 06:11For example,
  • 06:12if we are taking out ovaries on
  • 06:14somebody that we can actually start
  • 06:16estrogen therapy in the recovery room,
  • 06:18and we've done that on many people.
  • 06:20So for example,
  • 06:21and this is going to sound jarring to folks,
  • 06:24we have a large program,
  • 06:26many women who are
  • 06:27what we call previvors.
  • 06:29Women who are for example
  • 06:31carrying the BRCA gene who are
  • 06:32just fine but are having their
  • 06:34ovaries taken out preventatively.
  • 06:36And many of these women are
  • 06:38quite young,
  • 06:38they'll be women in their 30s,
  • 06:40early 40s again,
  • 06:41who are making a good level of estrogen.
  • 06:43But in those women actually
  • 06:44estrogen is not contraindicated
  • 06:46as long as they have not had breast
  • 06:48cancer or anything like that and
  • 06:49we're just taking out ovaries
  • 06:51as a preventative measure that
  • 06:52we can actually give those women
  • 06:54estrogen in the recovery room.
  • 06:56We can slap a patch on and
  • 06:58they'll be just fine.
  • 06:59So there are things that we can do
  • 07:00and we doing to encourage women to
  • 07:02discuss this with their providers
  • 07:04before surgical interventions or before
  • 07:06chemotherapy and radiation therapy.
  • 07:08And talk a little bit
  • 07:10Mary Jane about the symptoms that
  • 07:12people face when they are faced
  • 07:14with menopause due to treatment.
  • 07:16Whether it's due to chemotherapy
  • 07:17or radiation or surgery,
  • 07:19is this more than just hot flashes?
  • 07:21Talk a little bit about
  • 07:23all of the symptoms that you get
  • 07:26with that big lack of estrogen?
  • 07:28There are a lot of symptoms
  • 07:30that are out there that people may or
  • 07:33may not understand or realize.
  • 07:35For example, as you point out,
  • 07:37hot flashes are sort of the classic.
  • 07:40You get all hot and
  • 07:42then you start sweating, you
  • 07:43lose heat and you get cold.
  • 07:45However, there are also women
  • 07:47who will get problems with sleep.
  • 07:48The sleep disruption can be
  • 07:50quite a problem for many women.
  • 07:52And then there are symptoms
  • 07:53that people don't think about.
  • 07:55For example, one common symptom
  • 07:56that nobody really thinks about
  • 07:58particular things like joint aches,
  • 07:59muscle aches and a sense of achiness,
  • 08:01which would be pretty pervasive.
  • 08:02And women won't attribute that to menopause,
  • 08:04but indeed, that's something that can happen.
  • 08:07Women can get symptoms with vaginal dryness,
  • 08:09so that's usually a little bit later.
  • 08:11It isn't one of the initial symptoms,
  • 08:12but can be.
  • 08:13Woman can have bladder issues.
  • 08:15People can get leakage of urine or
  • 08:18problems with urinary tract infections,
  • 08:19all of which can be related
  • 08:21to that loss of estrogen.
  • 08:23So there are a lot of symptoms
  • 08:25that are out there and I'll make
  • 08:28a little plug here if I can,
  • 08:30if people want some more information on that,
  • 08:33if they can go to my website
  • 08:35which is Madame Ovary,
  • 08:36http://madameovary.com/
  • 08:37We have several videos and podcasts
  • 08:39on there about menopausal transition,
  • 08:41particularly menopause for
  • 08:42cancer survivors that might
  • 08:43be of interest and helpful for them.
  • 08:45You know one of the questions
  • 08:48Mary Jane is when people get
  • 08:51estrogen replacement
  • 08:53after they've had these therapies,
  • 08:55they may be wondering about whether
  • 08:57that estrogen replacement increases
  • 08:59their risk of subsequent cancers.
  • 09:00That's another excellent question,
  • 09:02and this is something that
  • 09:05women, I shouldn't say just women,
  • 09:07their families are concerned about as well,
  • 09:09and the good news is that,
  • 09:12for example, in very young women,
  • 09:14for example,
  • 09:16our young BRCA people that
  • 09:17we do know actually that they are
  • 09:20actually safer healthwise,
  • 09:21probably getting the estrogen
  • 09:23than not getting the estrogen.
  • 09:24Because we've actually shown
  • 09:26with data in some observational
  • 09:27studies that the young women who
  • 09:30get the estrogen therapy do not
  • 09:32experience an increased risk of breast cancer.
  • 09:34And then the other thing though,
  • 09:36that by giving them estrogen,
  • 09:38we're also substantially reducing
  • 09:39their risk of getting heart disease
  • 09:41or osteoporosis problems or even
  • 09:43dementia from not taking estrogen.
  • 09:44We know that young women who
  • 09:46are deprived of estrogen can run
  • 09:48into these certain health problems.
  • 09:50So we were actually doing health
  • 09:52benefits by giving the estrogen
  • 09:55not detracting from their health.
  • 09:57So something that they clearly need to
  • 10:00talk to their doctor about and the other
  • 10:03question of course,
  • 10:05and something that people may be a
  • 10:08little bit uncomfortable talking
  • 10:10to their doctor about is this
  • 10:12whole concept of sexuality and the
  • 10:14impact of estrogen deprivation on
  • 10:17that aspect, can you talk a
  • 10:19little bit about that?
  • 10:20Sure, there are huge issues involved there,
  • 10:22particularly the main problem
  • 10:23that women face is vaginal dryness,
  • 10:25which is a very very common problem.
  • 10:27It's not one of the initial problems,
  • 10:29usually the hot flashes
  • 10:30are more annoying.
  • 10:31First, vaginal dryness tends
  • 10:32to appear a bit later,
  • 10:34but that can be very problematic.
  • 10:36The good news is, there isn't a problem
  • 10:38I don't have an answer for,
  • 10:40we've got lots of answers and there
  • 10:43are many products over the counter
  • 10:45that one can use which are totally non
  • 10:47hormonal which are absolutely
  • 10:49fine for the vagina and they're
  • 10:51available over the counter.
  • 10:52Non hormonal suppositories, creams,
  • 10:54which are long acting,
  • 10:56vaginal moisturizers.
  • 10:57The other thing we encourage women to
  • 11:00use are lubricants at the time of sex
  • 11:02in addition to using a vaginal moisturizer,
  • 11:05and they're quite effective.
  • 11:06The other thing that women should
  • 11:08realize is that we can actually
  • 11:11safely use vaginal estrogen.
  • 11:12Vaginal estrogen is a pretty different
  • 11:14phenomenon than using systemic
  • 11:16estrogen in the form of pills,
  • 11:18oral pills, or patches
  • 11:19and we have some very good
  • 11:21data and some papers put out by the
  • 11:23North American Menopause Society
  • 11:25and the American College of OBGYN
  • 11:27showing that the amount of
  • 11:29estrogen that is absorbed from
  • 11:31the vagina is so small that many
  • 11:33women who have breast cancer may
  • 11:35safely use vaginal estrogen.
  • 11:37So if the over the counter medications
  • 11:39aren't helpful enough for the vaginal
  • 11:41moisture issue in lubrication,
  • 11:42we can actually use vaginal estrogens.
  • 11:47And so I think the other
  • 11:52whole aspect aside from
  • 11:55being tossed into menopause,
  • 11:58particularly for young cancer survivors,
  • 12:00is this whole concept of
  • 12:04the emotional aspect.
  • 12:07The aspect of
  • 12:12this sense of an altered
  • 12:16body image, altered self esteem.
  • 12:18Talk a little bit about how
  • 12:21we can help patients through that.
  • 12:23Well, it's
  • 12:24another excellent point. And indeed
  • 12:26these issues do come up regularly.
  • 12:28People who have had
  • 12:30a significant surgery taken off body
  • 12:32parts or people ending up with different
  • 12:35ostomies and things like that as result
  • 12:37of their cancer surgery and what we
  • 12:39always certainly in our program,
  • 12:41and we have a program at Yale,
  • 12:43but there are programs in many hospitals
  • 12:46around the country who take care of cancer
  • 12:48patients who deal with these issues and
  • 12:51refer to things like sexuality,
  • 12:52intimacy and menopause type programs,
  • 12:54and as part of these programs,
  • 12:55most of them have a
  • 12:57psychologist working with them,
  • 12:58which is a wonderful.
  • 13:03Because we discuss these issues.
  • 13:04How are you feeling about these changes?
  • 13:08How do we make them better?
  • 13:10But how are you feeling about it and
  • 13:12how can we help you deal with them?
  • 13:15So in addition to doing our physical
  • 13:17interventions as far as some medications
  • 13:19or exercises or things like that,
  • 13:21that can be helpful.
  • 13:22We always want to talk to people about
  • 13:24how are they feeling psychologically and
  • 13:25we do like to hook people up with some
  • 13:28psychologists who are schooled on these
  • 13:29kind of issues to help folks deal with
  • 13:32their new new body image.
  • 13:33How do we deal with those kind of issues?
  • 13:37It's important to really think about the
  • 13:39whole patient and we're going to learn
  • 13:41a lot more about how we take care of
  • 13:44the whole patient when they're dealing
  • 13:46with menopause with cancer
  • 13:48after we take a short break for a
  • 13:50medical minute. Please stay tuned
  • 13:52to learn more with my guest Doctor
  • 13:54Mary Jane Minkin.
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  • 15:00Welcome
  • 15:00back to Yale Cancer Answers.
  • 15:02This is Doctor Anees Chagpar
  • 15:04and I'm joined tonight by my
  • 15:06guest Doctor Mary Jane Minkin.
  • 15:08We're talking about menopause
  • 15:10and cancer. Mary Jane,
  • 15:12right before the break we were
  • 15:14talking about the fact that,
  • 15:16you know, for many young breast cancer
  • 15:19and ovarian cancer survivors to be
  • 15:22tossed into menopause when they weren't
  • 15:24expecting to be in menopause at that
  • 15:26age, that can take not only
  • 15:29an emotional toll but a real toll on
  • 15:32their self image and their
  • 15:34whole concept of sexuality
  • 15:36and you were mentioning how a
  • 15:39psychologist is part of the team
  • 15:41talk a little bit about libido.
  • 15:44I mean this is something that you
  • 15:47know for many cancer survivors,
  • 15:49indeed, for many patients in
  • 15:51general is not generally something
  • 15:53that you bring up to your doctor.
  • 15:56So do we have ways of dealing with that?
  • 15:59Or are people just told to live with it?
  • 16:03Well, we never say just
  • 16:05live with it to just about anything.
  • 16:07I think we have help for just
  • 16:09about everything that's out there.
  • 16:10So that's number one.
  • 16:12For example, with libido,
  • 16:13the first thing that I discuss when I
  • 16:15have a patient who's describing
  • 16:16that she's got decreased libido and
  • 16:18I'm delighted patients bring it up.
  • 16:19I'm sorry they're dealing with it,
  • 16:21but I'm delighted they bring it up
  • 16:23cause we can happily chat with
  • 16:25them and help fix it.
  • 16:26The first thing I always tell
  • 16:28people is how's your vagina doing?
  • 16:29And many people look at me and say,
  • 16:31well, it's drying miserably
  • 16:32but that's not the issue.
  • 16:34And I say, Oh yes,
  • 16:35it is because the key thing is that
  • 16:38with painful
  • 16:40sex, what normal person would want to
  • 16:42have sex if it hurts, that's crazy.
  • 16:44So I feel it's my obligation to help
  • 16:46them get comfortable, to get a happy
  • 16:48healthy vagina first so that
  • 16:50they're comfortable and indeed,
  • 16:51with half of my patients when
  • 16:53we do get them comfortable,
  • 16:55they'll say,
  • 16:56that was really the problem.
  • 16:58It wasn't my lack of libido, it was discomfort,
  • 17:00so we really focus on getting
  • 17:02them comfortable.
  • 17:02One thing I didn't mention as
  • 17:04far as vaginal issues,
  • 17:06and a thing we use
  • 17:08fairly regularly for women with
  • 17:09vaginal dryness and problems after
  • 17:11cancer are vaginal dilators,
  • 17:12which are readily available,
  • 17:13we have them in many different varieties.
  • 17:16And really can help stretch the
  • 17:17vagina to get it back to normal,
  • 17:20and even if a woman hasn't been having
  • 17:22sexual activity for a number of years,
  • 17:24we do get some women
  • 17:25coming to visit us who have just
  • 17:28been miserable for a long time.
  • 17:29And finally, it's like OK,
  • 17:31it's time to do something,
  • 17:32and we can fix just about
  • 17:35everybody's vagina so
  • 17:36with the help of dialators,
  • 17:37moisturizers, things like that,
  • 17:38so never give up.
  • 17:39It's never too late to investigate,
  • 17:41but there are plenty of women,
  • 17:43for half of them, that will fix the vagina,
  • 17:45and they'll be comfortable,
  • 17:46totally comfortable,
  • 17:47but still could care less,
  • 17:49and that's a different issue.
  • 17:51And of course,
  • 17:53we do have them speaking with our psychology folks.
  • 17:55As far as things like body image
  • 17:56and how can you make time together
  • 17:59happier and more
  • 18:00enticing, more libido.
  • 18:01And we do have some medical approaches
  • 18:03as well that can be helpful.
  • 18:05Non hormonal as well as hormonal
  • 18:06that we can safely use to enhance libido.
  • 18:09So there are a lot of things to do and some
  • 18:12counseling is very important because,
  • 18:13again, if you haven't,
  • 18:15communicated with your
  • 18:16partner for a long time,
  • 18:17for whatever issues going on,
  • 18:21no matter what it is,
  • 18:22you really want to get
  • 18:24communication between partners and
  • 18:25let them talk about
  • 18:27what's going on and why they
  • 18:28haven't been feeling like having
  • 18:30sex and just bring things out in the
  • 18:32open and it can be very helpful again,
  • 18:34and we do have medications,
  • 18:35both hormonal and non hormonal.
  • 18:38And I think the issue of bringing the
  • 18:41partner into the conversation is so
  • 18:43important because it does take two to
  • 18:46tango and sometimes it can be,
  • 18:49you've just gone through this
  • 18:51pretty traumatic event in your life and
  • 18:54that may change other peoples perception.
  • 18:56They may not know what they
  • 18:58can do or can't do more,
  • 19:00be comfortable or not comfortable.
  • 19:02So how do you approach the partner?
  • 19:06Our program, and I think in most
  • 19:08programs that deal with these issues,
  • 19:10we encourage partners to come with the
  • 19:12patient
  • 19:14and actually sometimes
  • 19:15that's one advantaget to
  • 19:17TeleHealth, it has certain advantages,
  • 19:19certain disadvantages, to be sure,
  • 19:20but oftentimes we can have a partner
  • 19:22come on board via TeleHealth
  • 19:25visit and then we can talk to both people,
  • 19:27which is very nice.
  • 19:28And you know, we've talked
  • 19:30to partners on many occasions.
  • 19:31We also, of course, welcome partners
  • 19:33to come with patient to
  • 19:35the office visits with us too,
  • 19:37so that we can talk with everybody and the
  • 19:39psychology folks can talk with everybody.
  • 19:41And again,
  • 19:42we always encourage communications,
  • 19:43ust talk to each other.
  • 19:45Sometimes having us there
  • 19:47in the middle is a good thing.
  • 19:53Just getting the people to communicate
  • 19:55is really very, very important.
  • 19:56What do you like?
  • 19:58What don't you like?
  • 19:59What's going on?
  • 20:00Let's talk about it and it's really important
  • 20:03and I can't emphasize that enough.
  • 20:05Speaking of talking things through,
  • 20:07this whole concept
  • 20:08is just difficult to bring up.
  • 20:11I mean, it's difficult
  • 20:12for many patients to talk about
  • 20:14sexuality with their doctors,
  • 20:16it's difficult for doctors sometimes
  • 20:18to ask about people's sexual health.
  • 20:20It's difficult for people to talk about,
  • 20:23you know their feelings about menopause,
  • 20:25so how do you
  • 20:28recommend on both fronts?
  • 20:30How do you recommend patients
  • 20:32bring it up to their doctors?
  • 20:35And what advice do you have for
  • 20:37clinicians who might be listening
  • 20:39as to how to broach the topic?
  • 20:42Especially if they're not
  • 20:44very comfortable with that?
  • 20:46Well, if they've been my medical student,
  • 20:48they've had me yell at them and say you
  • 20:50gotta feel comfortable walking into any
  • 20:52patients room and saying how's your vagina?
  • 20:54Well, maybe not a guy, but
  • 20:56for your female patients,
  • 20:57it's an important topic and we should
  • 20:59deal with the vagina just like we
  • 21:01deal with heart or lungs or stomach.
  • 21:03It's another body organ and we
  • 21:05want to be comfortable talking about
  • 21:07it, it's a very important organ.
  • 21:09And the other thing is, is there are
  • 21:11a lot of surveys that have been
  • 21:13done asking patients,
  • 21:14do you want to talk about sex
  • 21:16and the overwhelming majority
  • 21:17of patients in these surveys
  • 21:19tend to say, yeah,
  • 21:20I'd like to talk about sex and I
  • 21:22would like my provider to bring it
  • 21:24up but many people say I don't
  • 21:26want to bring it up 'cause my patient
  • 21:28will be embarrassed talking bout it.
  • 21:29No.
  • 21:30The vast majority of these
  • 21:31surveys say the patient really
  • 21:33would like to talk about these
  • 21:34issues and they really would like
  • 21:36you to inquire so that you're doing
  • 21:38something to help your patient
  • 21:39not to embarrass your patient.
  • 21:40So don't be afraid to go in and
  • 21:42say, these things are
  • 21:43going on and
  • 21:46for providers listening,
  • 21:47one of the things that people talk about
  • 21:50are ubiquity questions
  • 21:51to say to a patient,
  • 21:53many women who have
  • 21:55gone through this experience have
  • 21:56issues with vaginal dryness or they
  • 21:58experience issues with hot flashes,
  • 22:00issues with libido and
  • 22:02is this a problem that you're facing
  • 22:04and can I help you with it and just
  • 22:07the validation that these problems are
  • 22:09real and God knows we know they are real.
  • 22:11So if you have the situation validated
  • 22:13and posing it to the patient to say
  • 22:16many women do experience
  • 22:18this and it has been a problem.
  • 22:20And can we talk about it and can
  • 22:22I help you, just validating it and
  • 22:24just bringing it into the open is
  • 22:26a real value for the patient and
  • 22:28her partner as well.
  • 22:30It's so important, and I think that
  • 22:32that's such a nice way to kind of
  • 22:36broach the topic that might be
  • 22:38uncomfortable on both sides.
  • 22:44I think the other thing is,
  • 22:47as you kind of coined it,
  • 22:50the ubiquity of things, right?
  • 22:52So you know the concept of sexuality,
  • 22:55the concept of menopause are
  • 22:58things that are ubiquitous and
  • 23:00people experience
  • 23:01and go through them.
  • 23:04So even for people who may not be
  • 23:07tossed into menopause as a result of
  • 23:10a particular diagnosis and treatment,
  • 23:13for example,
  • 23:14for patients who may have cancer
  • 23:17and be going through menopause,
  • 23:20but maybe having a hard time with it
  • 23:23but are still afraid of their risk.
  • 23:27So we're now talking about
  • 23:29post menopausal patients.
  • 23:31What advice do you have for them?
  • 23:33The thing
  • 23:33that I can tell folks, first of all,
  • 23:36it's wonderful these days to be able
  • 23:38to talk a little bit about menopause,
  • 23:40which is a little less of a taboo topic
  • 23:42than it used to be, I mean,
  • 23:45for example, I think people may not realize
  • 23:47even Michelle Obama recently made a
  • 23:49podcast talking about hot flashes,
  • 23:50which I know is terrific.
  • 23:52Where we get people,
  • 23:54famous, elegant people talking
  • 23:55about hot flashes and menopause.
  • 23:57That sort of validates the discussion
  • 23:59in and of itself, which is great.
  • 24:01And of course, in our society,
  • 24:02one reason people oftentimes don't
  • 24:04like to discuss menopause is that
  • 24:06menopause goes along with us
  • 24:07getting older, as we get older we are
  • 24:09more likely to go through menopause.
  • 24:11And we're in a society,
  • 24:12unfortunately,
  • 24:13where youth is revered instead of people
  • 24:15being older and smarter getting revered.
  • 24:17Whereas in societies where the elders
  • 24:19are the revered people in the society,
  • 24:22people go to them for knowledge and
  • 24:24questions and things like that.
  • 24:26Menopausal symptoms actually tend
  • 24:27to be much better dealt with.
  • 24:32But if you can have people talking,
  • 24:35being willing to talk about this
  • 24:37that we have therapies.
  • 24:41For example,
  • 24:42somebody who's dealing with
  • 24:43whatever symptomatology and
  • 24:44whenever she's dealing with,
  • 24:46we have many,
  • 24:47many options out there for therapy.
  • 24:49And yes,
  • 24:49hormonal therapies is a
  • 24:51mainstay of treatment,
  • 24:52and it works quite well for many people.
  • 24:55But if,
  • 24:55for example,
  • 24:56you were having terrible hot flashes
  • 24:58and you really very anxious without
  • 25:00taking any hormonal therapy we've got
  • 25:02lots of options out there which can
  • 25:05be quite helpful for symptoms and
  • 25:07we have herbal products out there
  • 25:09that we can talk about.
  • 25:11And then there are medications,
  • 25:13for example something many people
  • 25:15may not realize is that antidepressants,
  • 25:16happen to
  • 25:18work very well for hot flashes.
  • 25:26And I dont know if you know this, that the use of
  • 25:28anti depressants for hot flashes
  • 25:30was actually discovered in men.
  • 25:34It was the folks at the Mayo Clinic
  • 25:37and they found this out that in
  • 25:39men who were being treated
  • 25:42with hormonal suppression
  • 25:44that men would get hot
  • 25:46flashes and that they found out
  • 25:48that antidepressants seemed
  • 25:50to help their hot flashes so the
  • 25:53breast cancer folks
  • 25:54actually brought it over from the knowledge
  • 25:56that we accrued from the
  • 25:58prostate cancer patients.
  • 26:01But for example, it
  • 26:03was found out sort of serendipitously,
  • 26:05but we know that those can be
  • 26:07very helpful for hot flashes.
  • 26:09Another medication that's out there
  • 26:12gabapentin which is used often times
  • 26:13by neurologists for pain or seizures,
  • 26:15things like that also have some
  • 26:17anti hot flash properties.
  • 26:18So there are a lot of different
  • 26:20options that we can offer people
  • 26:21if they want to take hormones.
  • 26:23So we have many many choices.
  • 26:31The other thing
  • 26:32that is interesting,
  • 26:34and I think many of our listeners may be
  • 26:37particularly interested in, is
  • 26:40patients often say listen,
  • 26:42I don't particularly want
  • 26:43another pill in the pill box,
  • 26:45and the whole concept of
  • 26:48one medication on top of another,
  • 26:51but the idea of natural or herbal
  • 26:54products that are out there,
  • 26:56there is this burgeoning
  • 26:58field of naturopathic kind
  • 27:00of complementary therapies.
  • 27:01Talk a little bit about some
  • 27:03of the things that you might
  • 27:05try if you're having menopausal
  • 27:07symptoms that are herbal remedies,
  • 27:09maybe things that you can get over the
  • 27:12counter.
  • 27:14Unfortunately, part of the problem is
  • 27:16that we do live in the United States,
  • 27:19which is a problem.
  • 27:20Why am I saying that?
  • 27:22Unfortunately, herbal products are not
  • 27:24super well regulated in the United States.
  • 27:26However, there are many products
  • 27:28made in foreign countries where
  • 27:30they are pretty well regulated.
  • 27:31An example in Germany and Sweden they
  • 27:33have some very well regulated products
  • 27:35that are out there that are actually
  • 27:38fairly efficacious for hot flashes.
  • 27:40For example,
  • 27:41a remedy that's been used in Germany
  • 27:43for about 50 years for breast
  • 27:45cancer survivors has been a
  • 27:46black cohosh product called
  • 27:48Remifemin which has been out there
  • 27:50for over 50 years and works quite
  • 27:52well for hot flashes and is actually used
  • 27:54in German breast cancer centers
  • 27:56regularly so there are some herbal
  • 27:58products on Swedish pollen extract
  • 28:00that's out there that a lot of
  • 28:02different herbal products which do
  • 28:03seem to have some value for people.
  • 28:05But again you have to be careful
  • 28:07just 'cause it's an adorable
  • 28:09product doesn't necessarily make
  • 28:11it good.
  • 28:13I think one of the messages always is talk to your doctor.
  • 28:16And find out how whatever medication,
  • 28:19whether it's herbal or not,
  • 28:21that you're taking reacts with the other
  • 28:24things.
  • 28:28Mary Jane, maybe in
  • 28:29our last minute you can kind of talk
  • 28:31a little bit about whether there
  • 28:34there are interactions that people
  • 28:36should be aware of when they're
  • 28:39going through cancer treatment.
  • 28:41And some of these products, are they
  • 28:44all pretty safe to use when
  • 28:48getting other kinds of therapies?
  • 28:49That's an excellent question.
  • 28:51Probably the most commonly
  • 28:53used product that may be an issue,
  • 28:55particularly hormonal type interventions
  • 28:56is actually Saint Johns wort.
  • 28:58We actually know that Saint Johns
  • 29:00wort decreases the effectiveness
  • 29:01of birth control pills,
  • 29:02so we just try to discourage people
  • 29:05taking birth control pills from using it.
  • 29:07So that's probably the most common
  • 29:09one in the herbal armamentarium
  • 29:10that can be problematic.
  • 29:12Doctor Mary Jane Minkin is Co
  • 29:15Director of the sexuality intimacy and
  • 29:17Menopause Clinic at Smilow Cancer Hospital.
  • 29:19If you have questions,
  • 29:21the address is canceranswers@yale.edu
  • 29:22and past editions of the program
  • 29:24are available in audio and written
  • 29:26form at yalecancercenter.org.
  • 29:28We hope you'll join us next week to
  • 29:31learn more about the fight against
  • 29:33cancer here on Connecticut Public Radio.