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Young Women & Breast Cancer

Addressing Long-Term Side Effects


Breast Cancer image

Once you have com­pleted treatment for breast cancer, you may have some lingering side effects. Where you once felt like a healthy young woman, you may now encounter what feels like constantly changing physical ailments. It is natural to become frustrated with these issues, but knowing what to look for and open communication with your medical team can help alleviate symp­toms and worry.

Early Menopause
Menopause occurs when a woman’s ovaries stop producing hormones and menstrual periods stop. Menopause happens naturally as a woman ages. In young women, however, cancer treatment can cause early menopause by damaging the ovaries and affecting their ability to produce hormones. As a result, men­strual periods stop. For some cancer survivors, menopause is temporary and menstrual cycles resume. For others, menopause is permanent. Symptoms of menopause may include:

  • hot flashes
  • night sweats
  • sleep problems
  • trouble concentrating
  • vaginal dryness
  • painful or uncomfortable intercourse
  • loss of interest in sex
  • depression, anxiety, irritability, or mood swings
  • weight gain
  • memory problems

In young women, cancer treatment can cause early menopause by damaging the ovaries and affecting their ability to produce hormones.

Talk to your doctor about your symp­toms of menopause, especially if they are bothering you or interfering with your daily activities. He or she may have suggestions specific to your situa­tion. The following suggestions for lessening the effects of menopause on your daily life may be helpful:

  • Notice what triggers your hot flashes, such as caffeine, alcohol, stress, fatigue, or spicy foods, and avoid them when possible.
  • Dress in layers, and use a portable fan in your office or home.
  • Use a water-based vaginal lubricant to ease vaginal dryness. This may also make sex more comfortable.
  • Try drinking something warm before bedtime to help you sleep, such as caffeine-free tea or warm milk.
  • Keep your bedroom dark, quiet, and cool, and use it only for sleep and sex­ual activities.
  • Look for ways to reduce your daily stress.
  • Keep physically active.
  • Join a support group for young women with breast cancer. Talking to others who are experiencing early menopause can be helpful.

Birth Control
There is a lot of infor­mation out there about birth control and what method is best for young women with histories of breast cancer. You may have heard that the hormones in many birth control pills, injections, or patches increase a woman’s risk of breast cancer or that they affect long-term fertility.

Generally, for women who have a personal history of breast cancer, hormonal contraception like the birth control pill is not recommended. Hormonal methods, which also include injections like Depo-Provera, intrauter­ine devices, birth control patches, and vaginal rings, can prevent pregnancy by interrupting the normal female cycle and decreasing the chances of ovulation and conception. They typically contain a combination of estrogen and proges­terone. As such, particularly for women who have had a hormone-receptor type breast cancer, these contraceptive methods are generally advised against.

Remember that feeling sexy is about self-esteem, and that can only come from within.

Barrier methods, such as male and female condoms, diaphragms, and vaginal caps, do not contain hormones and work by physically blocking fertil­ization and conception. When used correctly and consistently, they are a safe and effective form of birth control. They may be used in conjunction with spermicide gels for additional protec­tion. In order to work effectively, these methods must be used each time you have sexual intercourse.

Young women may also wonder about the safety of hormone levels in emergency contraception – sometimes known as the morning after pill. Be­cause of the short-term use of these pills, the increase of hormones in your body is not significant enough to affect your risk of breast cancer.

It’s important to talk to your doctor about birth control, as he or she can recommend the best method of contra­ception for your specific situation.

Sex and Intimacy
Whether you are single, partnered, or in a long-term relationship, breast cancer survivors can face intimacy issues after treatment. It causes changes in your body that can affect your desire for and enjoyment of sex. The main concerns expressed by young survivors that affect their sex life are vaginal dryness, vaginal pain, body image, and reduced interest in sex. Body image is a significant issue for many young women with breast cancer. Scars, the loss of breasts, changes to erogenous zones, weight changes, and hair loss can also contribute to feeling unattractive or less than sexy. Remember that feeling sexy is about self-esteem, and that can only come from within. Get to know your body and its needs, as they may be new or different than before you began treatment. Concen­trate on your own well-being and believe that you deserve to be admired, loved, and able to experience intimate pleasure. If you are having trouble overcoming these issues, you may want to see a licensed therapist to help you work through them.

Although it may be difficult, talk with your doctor about changes in your interest in sex and any physical changes that may make sex difficult. Problems with sexuality and intimacy can be physical, biological, psychological, social, and spiritual. Cancer treatments can cause early menopause or meno­pausal symptoms that may contribute to vaginal dryness. Hot flashes may happen during intimate moments. Antidepressants can cause decreased libido. If you are not comfortable talk­ing with your oncologist, see a licensed sex therapist or counselor who special­izes in working with cancer survivors. Taking care of physical symptoms may solve problems that you thought were more difficult to treat.

Treat vaginal pain if you have it. There are several causes of vaginal pain. Certain chemotherapies can cause pain­ful ulcers in the vagina. Steroids and antibiotics can increase the likelihood of getting yeast infections in the vagina. Low estrogen levels cause vaginal tissue to thin, dry, and lose elasticity. The good news is help is available for vaginal pain. If you are having pain with inter­course, get it checked out by your doctor.

If the cause of pain with intercourse is vaginal dryness, use personal lubri­cants. There are many different kinds of lubricants intended for use during intercourse, and there are moisturizers that generally moisten and strengthen the walls of the vagina. Remember to use water- or silicone-based lubricants, especially if you are using barrier methods of contraception, for optimum efficacy. Some products can restore elasticity and moisture to the tissue of the vagina. It is important when think­ing about such products that you make sure they are not estrogen-based. You should also avoid products that contain petroleum, glycerin, or oil-based lubri­cants, as they may increase your risk for bacterial or yeast infections.

Kegel exercises can be done to strengthen the pelvic floor muscles. To find these muscles, you can practice cutting off your urine flow when you are urinating. The muscles that contract to stop the flow are the same ones you should contract when doing Kegel exercises.

Practice being intimate without having sex. Being close together with­out the pressure of having sex may allow you and your partner to relax and focus on feeling close and connected again. Open the lines of communication. Take time for both of you to talk about your fears and concerns, as well as your wants and needs. The time to talk about sex with your partner is outside the bed­room. It’s best not to bring up concerns about intimacy while being intimate or when one partner is trying to initiate intimacy. When you feel you are ready for intercourse, go slow and keep your partner informed of what hurts, what feels good, and when lubrication is needed. Remember that implementing new behaviors takes time and practice. Try to approach and experience these techniques with an open-mind, patience, and a sense of play.

Lymphedema
Because of the serious effects cancer can have on the lymph system, some cancer survivors also face the challenges of lymphedema – the build-up of fluid in soft body tissues. This happens when the lymph system is damaged or blocked, which often happens because of cancer, lymph node removal, and cancer treatment. Because of cancer, lymphatic system damages or blockage can occur due to infection, removal of lymph nodes, radiation to the affected area, or scar tissue from radiation therapy or surgery. For women with breast cancer, lymphedema usually happens in the arm.

Lymphedema may develop within a few days or even years after breast cancer treatment. Some conditions increase your risk: slow healing of the skin after surgery; a tumor that blocks the lymph duct or lymph nodes, or vessels in the neck, chest, underarm, pelvis, or abdomen; scar tissue in the lymph ducts under the collarbones caused by surgery or radiation therapy; and removal or radiation of lymph nodes in the underarm. The risk of lymphedema increases with the number of lymph nodes affected. When surgery only removes the sentinel lymph node (the first lymph node to receive lym­phatic drainage from a tumor), you have less risk of lymphedema.

Lymphedema can cause long-term physical, psychological, and social challenges – but you can also take some important steps to manage lymphedema and its challenges:

  • Talk to your healthcare team about your concerns and any symptoms you might have.
  • Consider consulting a physical ther­apist who specializes in lymphedema. This expert advice can help you deal confidently with your symptoms.
  • Contact the National Lymphedema Network by calling (800) 541-3259 or visiting lymphnet.org for research up­dates and additional information that might tell you how to better manage or treat this condition.

One misconception is that exercise can increase the risk of lymphedema. In the past, doctors told women not to exercise the affected arm. Studies now show that slow, carefully controlled exercise is safe and may even help you prevent lymphedema. In breast cancer survivors, upper body exercise does not increase the risk of lymphedema.

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For more advice, download or order your free copy of Young Survival Coalition’s What’s Next? A Young Woman’s Post-Treatment Navigator at YoungSurvival.org.

Reprinted by the permission of Young Survival Coalition from YoungSurvival.org.

This article was published in Coping® with Cancer magazine, May/June 2013.