Guest Blog | Medical Menopause and Breast Cancer

Written by Nichola Hewitt | 20 November 2019
You can follow Nichola on instagram @ocdwiththebigc

Cancer. When you hear those words, that is all you can think about. You are launched on a rollercoaster and are never sure when you will be able to get off it. It is over three years now since my diagnosis, surgery and chemotherapy, but there are still twists and turns that I am having to cope with. A rollercoaster is honestly the best way to describe it, as just when you think that you have dealt with all that cancer throws at you, it goes and completely turns your life upside down some other way.

When I was sat in the surgeon’s room being told that I had breast cancer, never in a million years did I imagine that I would soon be in a menopausal state…. I mean, that is what happens when you get older right?!! And what does breast cancer have to do with the menopause anyway? All that was going through my mind at the time was that I would have surgery and maybe chemotherapy, and then hopefully that would be it. My cancer was oestrogen-receptor positive, which meant it fed off the oestrogen in my body. It also meant that the team could try to minimise the risk of reoccurrence by using hormone therapy to lower my level of oestrogen. I started by having tamoxifen, and then they introduced zoladex, which is a monthly injection to suppress the ovaries and stop them making oestrogen. This injection therefore causes a temporary menopause. And it is blooming massive! (I swore the first time my lovely nurse injected it.) Once I had been having these for a few months, my oncologist swapped the tamoxifen to letrozole, as this blocks the oestrogen being produced elsewhere in the body. I have been on that combination for a couple of years, but my oncologist recently put me back onto tamoxifen instead after the side effects of everything became unbearable.

Dealing with a menopause on top of everything else is really hard and I have to say I wasn’t fully prepared for the changes it would make to me and my life. When my oncologist told me I was to have the hormone therapy and that I would become menopausal, it felt like yet another hurdle put in my way. They explained the list of side effects which accompany the menopause, but it was still a huge shock when I actually started to suffer from them. I hate to say it, but I became quite angry at the situation as I felt that I had already been through enough. It just didn’t seem fair. I do try to remind myself that I am lucky that there are things that can be done to protect me, but it does get hard sometimes to keep thinking that way.

I honestly feel like a different person. I am tired, much more than I ever have been, and I have no energy to do anything. I am a teacher, so I know that my job is full on, but whenever I have spare time at the weekends, I don’t want to go out and do stuff anymore. I would much prefer to stay curled up on the settee all the time. I also worry because I feel like I have no joy in anything either. My boyfriend wanted to go on holiday and I couldn’t think of anything worse… I mean, who thinks like that? I don’t want to go out in the evenings, I don’t want to go to parties, I feel like I am no longer the fun-loving person I used to be.

Hot flushes arrived… luckily I don’t seem to get night sweats often, but the flushes! They can be tough. My Macmillan nurse put me forward for acupuncture, and this helped an awful lot. I have no idea how it works or why it helps, but I would recommend it. And even if you don’t notice a difference, it is a nice half an hour when you can just lie down, relax and not have to do anything!

I hate the weight gain. I have always been someone who has never really had to exercise, but I did start getting into the gym just before my diagnosis. Obviously I cancelled my membership when I got ill, but I have still not got back into doing any sport. I just can never be bothered! I did try swimming, having found a nice quiet pool, but then after moving house, I am yet to seek out a new place to go. Lethargy takes over and after a day’s teaching, I can think of nothing worse than having to go out and exercise. But I hate how my body has become. I have middle aged spread, and I have had to donate so many clothes to charity as they no longer fit me. Looking at them in the wardrobe was getting me down, so I had a big clear out. I looked at them and longed for the body I had before, which could get into them, and I hated the fact that I couldn’t get them over my thighs anymore. I hate looking in the mirror – I could honestly just cry when I see how I look at the minute. It was hard enough losing a breast and facing that, but when I see the other changes on top it can become too much. I feel like my own worst enemy, as I know that I should exercise. I know that I should do something about it. But I have no motivation and no energy, and then I just beat myself up and go round in a vicious circle which I can’t seem to get myself out of.

Then there is the sex… or lack of it. I have zero libido and I feel so bad for my boyfriend. He has stood by me since the start, and then I seem to have turned into a grumpy old woman in a couple of years. I never feel like sex anymore, and I can’t have it either as I now suffer from vaginal atrophy due to the lack of oestrogen in my body. So on the few times we try, I end up not being able to. Maybe this is too much information, but it feels like I am being sliced open inside. This gets me down so much as I am someone who has always enjoyed this side of a relationship and I worry that the lack of sex will put distance between my man and I. My oncologist gave me an oestrogen pessary, which he said wouldn’t be a risk as it was localised oestrogen, and it did help when I used one a couple of times. I am meant to use them twice a week, but I still feel odd putting oestrogen in my body. As I have no desire for sex, I didn’t want to be putting them in for no reason, but then on the odd time I was up for it, I couldn’t do anything. Another vicious circle!

But I have to say that the worst side effect for me is the way the menopause and the treatment have affected my mental health. I am someone who suffers from depression anyway, and this has got so much worse. I cry an awful lot of the time and just never seem to laugh anymore. It is hard as I feel I should be so happy to have come through the worst, yet I feel so low all the time. And guilty for feeling this way.

On top of all of this is the fact that I cannot take HRT to help ease the side effects and make me feel a bit more normal again. My whole treatment now is based around having as little oestrogen in my body as possible, so HRT goes against everything we are doing. However, that means that there isn’t really anything I can do. The side effects are caused by a lack of oestrogen, but I need a lack of oestrogen to protect myself.
Sometimes it all feels so very unfair and I break down as I feel like I have already gone through so much. There just always seems to be something else I need to overcome or face up to, and it is exhausting. I have tried counselling, which does help, and I am on antidepressants, but I know that I will have these symptoms for as long as I have my treatment.

I have been talking with my oncologist, who has been worried about me – I seem to just cry whenever I go to see him! He thinks that I should come off the zoladex and just have tamoxifen, as he wants me to be enjoying my life. I cannot tell you how hard it has been to make the decision to change the treatment. I have thought about it for so long, talked to so many people and lain awake at night wondering what the best thing to do is. Everyone tells me that I should stop the injection and get some of my happiness and life back, but I can’t help being scared as I know that the injection and letrozole offers me the best protection. My oncologist has stressed that the percentage of increased risk of reoccurrence is so small, and that my quality of life has to be the most important thing. You have to live for the now, and I know that I am not doing that at the minute. I feel like I am having to choose in a way between quantity of life or quality of life, and to me that is just something I cannot decide. It is an impossible decision to make, so I am just putting my trust in my oncologist. He is one of the best there is and I know he has my back, so I am following his advice. I feel that is the only way I can manage this.

So that is where I am at the minute. I never thought that I would have breast cancer at the age of 36 or that I would start going through the menopause at 37, and I still feel trapped on that bloody rollercoaster! I know there will be yet another twist to come when I think about children, as I don’t know if I will be able to carry a child myself yet or if I will have the nerve to stop all treatment to try to get pregnant (I had my eggs frozen before the chemotherapy). I guess the only thing that helps keep me going is that I am not on it alone. I have met so many wonderful people on this journey, who I wouldn’t have had in my life without the cancer, so I am grateful for that. There are always people there to hold your hand… remember that 😊 xxx