Breast cancer put me into menopause in my 40s: What to know about saggy skin, painful sex

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October is Breast Cancer Awareness Month. On average, 84 Canadian women are diagnosed with breast cancer each day — and in 2018, I was one of them. Earlier this year, Olivia Munn revealed she's in medically-induced menopause after being diagnosed with breast cancer in April 2023. I immediately felt a knot in my stomach when I heard the news. April is always a bittersweet month for me; it's when my first child was born but also, it marks six years since I had my double mastectomy.

I can remember the morning of my surgery, standing bare-chested as my surgeon marked with a Sharpie all the areas he would be removing. I looked like one of my kid’s drawings, purple marker everywhere. Looking down at my miniature mounds, droopy from nine months of breastfeeding, I gave them a quick goodbye, eager to get the cancer out of my body. Sure, I was nervous, especially when they wheeled me under the harsh lights of the operating room, but I was ready.

A little over four hours later I woke up feeling sore but relieved that whatever was trying to kill me had hopefully exited my body. It was two long weeks of waiting for the final pathology results, celebrating my son’s first birthday and trying my best not to Google "What happens if breast cancer spreads?"

I took my sister with me to the follow-up appointment where we both let out an audible sigh of relief when my doctor reported that the cancer had been contained to the breast. I learned that I might not even need chemo, but would know more after I met with my oncologist.

We left the office ready to celebrate the good news. The oncology appointment wouldn’t be for another week but no matter what, I was prepared to do whatever it took to make sure I would be there for as many of my son's birthdays as possible.

It's important to openly share how difficult diagnoses impact women's lives — and how little we talk about them. Here's what you need to know about my experience.

What is medically-induced menopause?

My oncologist immediately put me at ease with her warm smile and calm demeanour. Years ago, everyone with breast cancer would automatically undergo chemotherapy, but today she explained that treatments are tailored based on tumour genetics and make-up.

Breast cancer is sneaky, and even after a double mastectomy, it can come back to areas of the body such as the bones, liver, brain and lungs — and this can happen many years later. In my case, estrogen and progesterone fed the tumour and my doctor wanted to be as aggressive as possible to cut off its hormone supply by putting me into medically-induced menopause, also known as chemical menopause.

Menopause? I was shocked. It seemed so extreme. I was 41. My mom didn’t go into menopause until her mid-50s. Was this really necessary? If I agreed, the plan was for me to receive the first of what would be monthly shots, to shut down my ovaries and put me into menopause.

While my doctor left to give me a few moments to think it over, I answered a call from my mother-in-law, who was watching my newly minted one year old. My son had just tried avocado and loved it. He had a lifetime of new things to explore and I wanted to be there for as many of them as I could. Menopause it is, I thought to myself. How bad could it be? A few hot flashes?

I soon discovered that menopause is so much more than hot flashes and changes you in ways I could have never imagined.

What happens to the body during medically-induced menopause?

For people who are not breast cancer patients, the process of menopause tends to happen in stages, with perimenopause to give the body time to adjust to the reduction of estrogen. But what happens when you immediately shut down or remove the ovaries?

“The side effects of induced menopause can be more abrupt than the symptoms experienced during a more gradual ‘natural’ menopause,” Dr. Robin Noble, the Chief Medical Officer of Let’s Talk Menopause, tells Yahoo Canada.

Of course everyone is different, Noble says. While some people experience very few symptoms, others can experience a host of symptoms such as hot flashes, skin changes, mood swings, painful sex, joint pain and heart palpitations. Skin changes are also significant when you deplete your body quickly of estrogen. "Estrogen impacts collagen and elastin as well as our immune system and vascular system–thus there are many impacts on the skin, skin thickness, blood flow and the appearance,” she explains.

Estrogen is also critical for bone health. Being put into menopause early caused my bones to weaken significantly. In order to combat this I consume 2,000 units of vitamin D everyday, incorporate strength training into my workouts and get an injection of a bone strengthening agent every six months. Each year I receive a bone density scan and a fracture risk assessment to monitor any changes. The best I can hope for is that I don’t lose too much more bone density but the chances of the damage being completely reversed is highly unlikely.

Brain fog during menopause

Brain fog can be one of the most frustrating parts of menopause. According to Dr. Eleonora Teplinsky, Head of Breast and Gynecologic Medical Oncology at Valley Health System, “brain fog or cognitive impairment can occur with menopause and/or endocrine therapy and can manifest in many ways such as forgetfulness, problems with concentration and focus.” The reason for this she says is “in part due to the decline in estrogen and can also be made worse by other side effects that can occur such as insomnia and hot flashes.”

Chemotherapy treatment can also make these side effects worse with some people referring to the condition as “chemo brain.” There’s something unsettling knowing that your mind is changing and the medicine helping to keep you alive is contributing to that change. Breast cancer takes so much from you that way.

Dr. Nilda Abellera, Chief Medical Officer of the integrated cancer center Infuze MD in Northern California, recommends upping your antioxidants from fruits and vegetables to help reduce hot flashes and adding flax seeds to your diet to help alleviate night sweats. Abellera tells Yahoo Canada that exercise and meditation are key for brain health as they “allow more oxygenation to the brain.”

Working out daily has been significant for me in mitigating any mental side effects. Following a mostly plant-based diet and adding in some fatty fish weekly has also helped my brain stay on point, well, mostly.

How does menopause impact sex?

Yes, the thinning hair sucks, and saggy skin is no picnic either, but one of the biggest challenges of being put into menopause is how it impacts your sex life. I love my husband so much and being intimate with him is amazing, but it’s been more challenging since having breast cancer. Many other survivors I know have voiced similar concerns and it can be a real struggle for their mental health.

Dr. Lauren Walker, Adjunct Associate Professor of the Department of Oncology, Division of Psychosocial Oncology at the Cumming School of Medicine, University of Calgary, says that because many breast cancer patients are “catapulted into estrogen deprivation or menopause virtually overnight,” sexual satisfaction is a prominent issue.

“About 80 per cent of breast cancer survivors will report sexual concerns, ranging from loss of sexual desire to sexual discomfort and pain with sexual activity as well as vulvovaginal health concerns like dryness,” Walker says.

“Women may also experience problems such as low libido (sex drive), pain, trouble reaching orgasm…,” Teplinsky says, adding that “psychological factors” can also have a huge impact after a breast cancer diagnosis. “Anxiety, depression, lack of intimacy with oneself or partner, body image concerns and loss of femininity can significantly impact sexual health.”

But all is not lost. There many things you can do to help overcome these issues. For vaginal dryness, Teplinsky suggests non-hormonal vaginal moisturizers and vaginal estrogen–which has been found to be safe for breast cancer patients. She also recommends pelvic floor physical therapy, vaginal dilators and psychosocial and psychosexual counselling.

Most importantly, I also remind you to be open with your partner. In the beginning, my husband thought I was rejecting him when in fact I was just trying to process what was happening. It was such a relief to be honest with him and things have been much smoother ever since.

Whatever it takes

Munn told People magazine, “Cancer doesn’t care who you are; it doesn’t care if you have a baby or if you don’t have time. It comes at you, and you have no choice but to face it head-on.” I’ve been in medical menopause almost six years and even with all the side effects and struggles, they have been some of the best years of my life. We welcomed our second baby via gestational surrogate and my sister and I surprised my parents with a trip to Italy for their 50th wedding anniversary.

Not every moment has been perfect and there have certainly been challenges along the way, but I got to live to do and see it all. So, I get my monthly shot and take my daily vitamins and pills and as long as it buys me more time with my family, more time to do all the things I love, it’s totally worth it.

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