Managing Sexual Concerns After Breast Cancer

Battling breast cancer can change a woman’s body in myriad ways. One change that many women are hesitant to discuss is how certain breast cancer treatments can trigger the onset of menopause and affect libido, intimacy, and sex. That’s why we asked Valerie A. Omicioli, M.D., gynecologist at Indiana University Health and a certified menopause practitioner with the North American Menopause Society, to demystify and address the sexual concerns that breast cancer survivors have.

Handling hot flashes and mood swings

Breast cancer treatments can affect the ovaries and cause them to stop producing estrogen and progesterone. While the adrenal glands may still produce a variety of hormones, breast cancer survivors often experience a significant hormonal imbalance after treatment that can lead to hot flashes, mood swings, lowered libido, and painful intercourse. Though hormone replacement therapy can help, most practitioners don’t recommend systemic estrogen to breast cancer survivors because estrogen can promote the growth of cancer. “Fortunately, for women who can’t take estrogen, we do have other options; they shouldn’t suffer in silence,” says Dr. Omicioli.

One option that your practitioner may suggest is antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs), which can be effective in easing both mood swings and hot flashes. “Research shows that SSRIs and SNRIs can reduce the frequency and intensity of hot flashes by 50 to 60 percent,” says Dr. Omicioli. “There is also another class of drugs called neuroleptics, such as gabapentin and pregabalin, which reduce hot flashes by 50 to 60 percent.” Finally, a blood pressure medication called clonidine has been found to reduce hot flashes by 40 to 50 percent. Ask your provider to work with you to determine which of these therapies may be best for you based on your health.

Dealing with dryness

A lack of estrogen can cause vaginal dryness and thinning of the vaginal tissues, which can make sex uncomfortable and even painful, explains Dr. Omicioli. But there is hope. Therapies exist that can alleviate the discomfort. Many women find relief with vaginal lubricants or vaginal moisturizers. These topical creams can be used several times a week and before sex.

Another option for some women is a vaginal hormone therapy (often inserted into the vagina as a gel or ring). Unlike oral hormone replacement therapies, local vaginal hormones release small amounts of estrogen to the vagina and the surrounding area, and very little gets into the bloodstream. Be sure to talk with your oncologist about the risks and benefits of this option.

Coming to terms with a new normal

“Under any circumstances, sexual function is quite complex and involves life factors such as relationship issues, career and personal stress, changing hormones as we age, and medications, among other things,” says Dr. Omicioli. “For breast cancer survivors, there are a whole set of additional issues, such as body image concerns after breast surgery.” To cope with the new status quo, Dr. Omicioli recommends that breast cancer survivors seek out help to deal not only with their physical symptoms, but also with their emotional symptoms. What’s more, she notes that relaxation techniques and exercise can also go a long way in helping both mind and body.

Talking openly with your provider

“An important thing to remember is that treatment for menopause should be individualized to each woman, and it should be decided jointly by the patient and provider,” says Dr. Omicioli. So talk honestly with your healthcare provider about your current symptoms and health history. What worked for your friend may not work for you. And what works for you at 45 years old may not work for you at 55 years old. “Therapies are not one size fits all—there are a lot of options that can make symptoms manageable for women,” adds Dr. Omicioli.