Q: My sister was just diagnosed with breast cancer. I quit taking my estrogen pills but the hot flashes and night sweats came back. Is there anything I can switch to that won’t increase my risk of breast cancer?
First, please talk to your doctor as soon as possible about your sister’s diagnosis and how it affects your own risk for breast cancer. Additional screening tests may be recommended for you.
Menopause brings many changes, such as night sweats, “hot flashes”, trouble sleeping, fatigue, thinning of your bones, and vaginal dryness. Taking supplemental estrogen can relieve these annoying symptoms and keep your bones strong, but also increases your risk of developing blood clots, breast cancer or having a heart attack.
Stopping your estrogen all at once can make these menopausal symptoms come roaring back. Tapering off estrogen is usually gentler and easier than just stopping it. Some years ago there was a study called the STAR trial (Study of Tamoxifen And Raloxifene), in which the women participating in it first had to stop taking their estrogen replacement medicine. The method that seemed to work best was skipping one day of estrogen in the first week, skipping two days of estrogen in the second week, skipping three days in the third week, and continuing that pattern until the ladies were off their estrogen completely .
The way the STAR trial tapered the estrogen was different than you might think. Instead of evenly spacing the skipped doses, they had the study participants skip Sunday’s dose in Week 1, Sunday and Monday’s doses in Week 2, Sunday, Monday, and Tuesday’s doses in Week 3, and so on. It really surprised me that it works fine either way you do it – by skipping estrogen pills bunched up in a row on Monday, Tuesday and Wednesday, or by spreading the skipped days out to Monday, Wednesday and Friday.
If you experience “hot flashes” or other breakthrough symptoms during your taper, I suggest going back to your previous week’s dose and staying on that for 2 to 4 weeks before trying to taper down again. Instead of doing only 1 week at each level, try staying at the level for 2 to 4 weeks before dropping another dose, then 2 to 4 weeks at the next lower level, and so on until you are completely off of the estrogen.
When we tell our medical provider we have “hot flashes”, the doctor knows what we mean, but that’s not what their medical books call it. I think it’s funny that the medical term used in textbooks for what we call a “hot flash” is a “hot flush”. When I think of a “hot flush” I see a high stakes poker game or a toilet bowl cleanser commercial with Mr. Clean clad in tight black leather pants.
After you have tapered off estrogen, what now? That depends on why you were taking estrogen in the first place. The two major benefits of taking estrogen are reducing menopause-related symptoms (the night sweats, “hot flashes”, and vaginal dryness) and preventing bone loss and future hip fractures from osteoporosis.
Adding a little bit of soy to your diet or taking the herbal product Remifemin® (a formulation of black cohosh) may help reduce “hot flashes”and night sweats. In order to prevent bone loss and osteoporosis you should talk to your doctor about prescription medicines that can protect your bones while decreasing your risk of breast cancer.
Prescription medicines called selective estrogen receptor modulators, or SERMs can act just like estrogen in some areas of your body while blocking the effects of estrogen in other areas. I call these “designer estrogens” because they are designed to mimic the benefits of estrogen supplementation and work in some tissues while having no effect on other parts of your body.
There are two SERMs available in the United States: Evista®, also called raloxifene, and tamoxifen. Evista® is prescribed to prevent and treat osteoporosis in postmenopausal women who can’t or shouldn’t take estrogen, either because they’ve had a blood clot, a stroke, or because of a high risk of developing invasive breast cancer. You can estimate your breast cancer risk at the National Institutes of health (NIH) website: www.cancer.gov/bcrisktool.
The older SERM, tamoxifen, is given to both men and women who have had breast cancer in after surgery or radiation to decrease the risk of a recurrance. Tamoxifen is also prescribed for breast cancer that has come back or has spread to other areas of the body.
October is Breast Cancer Awareness month. Please discuss your risk of breast cancer and osteoporosis with your medical providers, who are your partners in developing a strategy for prevention and early detection of breast cancer.
