Systemic HRT is not recommended as a first line therapy for breast cancer survivors and complementary or non hormonal options should be considered.
Women with ongoing menopausal symptoms are encouraged to discuss their options with their oncology team and menopause specialist. There are many options to try, from acupuncture, CBT and non hormonal treatments such as SSRI's and SNRI's. Usually, vaginal estrogens may be considered after switching aromatase inhibitors to Tamoxifen for adjuvant therapy.
Most women diagnosed with breast cancer will live with their cancer rather than die from it. More research is needed into the safety of estrogen based therapies in breast cancer survivors, especially receptor negative patients. For the moment, most guidelines will not recommend systemic estrogen based treatments. The North American Menopause Society NAMS looked for solid evidence of a few therapies that work and recommend SSRI's, SNRI's, Gabapentin, Clonidine, CBT and clinical hypnosis. The UK NICE guidelines (Nov 2015) indicate that SSRI's, SNRI's and Gabapentin are no better than placebo and that Paroxetine and Fluoxetine may reduce the efficacy of Tamoxifen. For breast cancer survivors NICE recommends Clonidine, Venlafaxine and Gabapentin though the guideline indicates that only St John's wort may improve symptoms it is not recommended because of serious drug interactions. Isoflavones, Red Clover and Black Cohosh are not recommended for breast cancer survivors by any international bodies. Few complementary or alternative treatment options have proven evidence of effectiveness, but there will be individual women who will benefit from some of these treatments. It is therefore important to have an individualised approach as you might be the one or two percent who responds extremely well to Isoflavones or Gabapentin. We are also realising more and more that there is a powerful placebo effect from almost every menopause intervention (up to 50-60%) and this may be due to improved chemical messengers that are created because you believe in the treatment option.
Our practitioners are trained to guide you through these rapidly evolving and potentially conflicting findings, communicating the risks to you and allowing you to choose the path and treatment which best meets your needs.