Hi Cazjen
First of all have a
and one from us all:
As far as HRT is concerned - you will have to consult a specialist - there are iters I am sure who mught have taken HRT after breast cancer on here although no-one comes to mind. There was a paper about it recently i think.
Re Vagifem - this will also need to be discussed with specialist as it might be contra-indicated if you are taking an aromatase inhibitor (like Letrozole) - it doesn't block oestrogen as such but prevents the enzyme (aromatase) from working which converts steroid precursors to oestrogen in the body.
In terms of anti-depressants - there was a paer produced a couple of eyars ago which went through what the best alternative treatements to HRT were for women who had had breast cacner. I don't think it's free any more - the paper - but I downloaded it when it was open access so will extract some of it for you.
Sorry it is formatted weirdly as it is a pdf:
"
Clonidine:alpha adrenergic receptor
agonist/licence class anti-hypertensive
and menopause symptom control
Clonidine is the only non-hormonal drug with a
licenced indication for control of hot flushes in the
UK.22 Clonidine 25 mg is prescribed twice daily for
two weeks increased to a maximum of 50 mg three
times a day. Evidence base is contradictory, although
one study shows significant reduction in the numbers of
hot flushes and improved quality of life compared with
placebo in breast cancer survivors using 100 mg
daily.23–25 Side effects of clonidine are dose related
and at higher doses clonidine causes sleep disturbance
in at least 50% of users. It must be withdrawn gradually
as abrupt cessation can cause rebound hypertension.
22 As an anti-hypertensive, clonidine may not be
suitable for patients with a baseline low blood pressure
Selective serotonin re-uptake inhibitors
(fluoxetine, paroxetine, citalopram,
sertraline) and the serotonin
noradrenaline re-uptake inhibitor/
selective serotonin re-uptake inhibitors
(SSRI-SNRI) venlafaxineSince paroxetine is the SSRI with the best evidence
for efficacy19,23 effective at 10 mg daily, it is the SSRI of
choice for patients not taking tamoxifen and the more
usual 20 mg dose chosen if an antidepressant effect is
also required.
Venlafaxine is the preferred treatment for breast
cancer survivors taking tamoxifen, and at 75 mg,
there is significant reduction in hot flushes with concomitant
improvement in fatigue, mental health and
sleep disturbance.2
Behavioural therapiesThe North American Menopause Society (NAMS)
Statement in 2015 recommends a CBT approach that
combines relaxation techniques, sleep hygiene and
learning to take positive healthy attitude to a menopause
challenge.21,46 One study found hypnotherapy
as effective as gabapentin in hot flush reduction.48
Supporting clinical studies demonstrated the effect in
reducing women's ratings of their hot flush problems.
Additionally, clinical hypnosis was found to have better
results than a structured attention approach in
post-menopausal breast cancer survivors. CBT is also
recommended as a treatment option for anxiety experienced
during the menopause transition and postmenopause.
A CBT approach which is theory based
can have an impact on both vasomotor symptom perception
and control and reduction in stress and wellbeing,
sleep problems and vasomotor symptomatology.
There are two-way interactions between mood and
vasomotor symptoms with 10% of women more likely
to have depressed mood during menopause. There is a
fact sheet (written by Professor Myra Hunter, Kings
College London) on the Women's Health Concern website
which provides guidance on cognitive behavioural
therapy almost in a self-help format for women to access directly.49 The recent appreciation of benefit
from behavioural therapies on vasomotor symptoms
perhaps suggests that the mechanism by which SSRIs
work for hot flushes could be as a result of their direct
class effect on mood.
Treatments for breast cancer survivorsMost women diagnosed and treated for breast cancer
will live with their cancer, rather than die from it.
A common consensus is to avoid estrogen replacement
therapy for breast cancer survivors. More research is
needed into the safety of possibly using estrogen-based
therapies11 particularly in receptor negative patients
but for the moment most clinical guidelines will consider
estrogen treatment contraindicated.9 Even BrCA
gene carriers who become menopausal following
risk-reducing surgery will be guided to take estrogen
replacement only up to the age of 50.9 There are a variety
of position statements, guidelines and consensuses
for management of vasomotor symptoms in breast
cancer survivors from International and National
Societies on the value and safety of alternatives.
5,11,16,21,27 A meta-analysis of adverse effects in
non-hormonal drugs in breast cancer survivors shows
a much higher level of adverse effects with 81% of
SAEs in one treatment group compared with those on
placebo, low dose therapies and acupuncture.5 The
NAMS Consensus Statement September 2015 looks
for solid evidence of a few therapies that work so as
not to waste patients' time experimenting with things
that really do not work.21 NAMS recommends SSRIs,
SNRIs, gabapentin, pregablin, clonidine, CBT and clinical
hypnosis. The UK guidelines, i.e. NICE CG 23 and
NICE CG 80 indicate that SSRIs, SNRIs and gabapentin
are no better than placebo and that paroxetine and
fluoxetine may reduce the efficacy of tamoxifen.11 For
breast cancer survivors, NICE CG 80 recommends clonidine,
venlafaxine and gabapentin although the NICE
2015 indicates that only St John's Wort may improve
symptoms, although not recommended because of serious
drug interactions.9,11,16
Isoflavones, red clover and Black Cohosh are not
recommended for breast cancer survivors by any of
the international bodies.5,16,21,27 "
I haven't copied the whole paper but chunks of it from:
Consensus statement for non-hormonal-based treatments for menopausal symptoms Jane Woyka 2017
Looks like the anti-depressant Venlafaxine might be worth a try and especially while you wait to consult a specialist about whether you can take HRT again.
There is more info which I can't remember so will post it when I find it.
Hope this helps...and take care
Hurdity x