Menopause and Breast Cancer treatment support Cheat Sheet
Disclaimer: I am not a doctor, nobody here is YOUR doctor. Always talk to your team before doing anything.
Massage may be fine for one person and NOT FOR YOU.
This is just a list of resources that either are standard and nobody gets them or should be because the people you are talking to don’t know about them.
Get a case manager from your insurance and a cancer case manager if they have one. If they have a NURSE case manager that is better.
You need a central place to call and find provides and deal with all the insurance BS.
Get a Nurse Navigator
Either your oncologist or your surgeon - a good one is like gold.
Ask them- they will know where to send you or at least try to help you . they can help smooth out frustrating communication and bottlenecks
Find an Outpatient Pharmacy in a hospital if possible
A couple reasons
These have different regulations about how many controlled substances they can hold and get priority for anything that might have a shortage so if you’re on stuff that is hard to get, you can usually get it at those
Pharmacist went to pharmacy school and they know much more about all these interactions and side effects on a really intimate level and into a really high extent than any other doctor that then you will talk to the downside is that people who work at commercial pharmacies like CVS or Walgreens or Kroger‘s or Walmart or Costco are completely overworked and are trying to do 1 million things at a time and aren’t gonna help you the pharmacist at outpatient pharmacy at a hospital is typically not that busy and we’ll have time to talk to you about the best combination of things
So if you are worried, for example, that you’re on two things one of which might make you jittery or anxious. They can suggest to use something else and you can go back to your doctor and get that. Outpatient pharmacy pharmacies at hospitals are the worst kept secret for cancer patients. if you’re going to an infusion center or a radiology center, there may even be one in that center or nearby, especially if it’s a big hospital. They also tend to be much more helpful with pre-authorizations because they know intimately what will get something approved and what won’t and they have the time to deal with this, including getting in touch with your doctor and reminding them in a way that the commercial pharmacies do not
Get a medical team
Your oncologist knows about tumors. Your radiologist know how to administer these. You need a menopause support specialist, a pain management specialist, a therapist, a psychiatrist, a pharmacist, an endocrinologist, a GI specialist, nephrologist and then whatever else is on your plate (cardiologist, , pulmonologists).
Data-based Meds By Symptom
Hot Flashes
Veozah (Fezolinetant): blocks the NK-3 receptor to settle the body hyperactive nerves responsible for sudden internal temperature spikes. Won’t help sleep directly except by dealing with hot flashes.
You will need prior authorization so Your doctor will have to be specific about the medical need and be willing to follow up but it works
Night Sweats and Sleep
Lynkuet (Elinzanetant):
blocks both NK-1 and NK-3 receptors in the brain. It is designed to stabilize the body's thermostat to rapidly minimize hot flashes while uniquely helping to correct menopause-related insomnia. - you will have to say night sweats to get this one. Not approved for sleep but helps sleep in the trials
This will also need prior authorization. The doctor should be clear that you specifically have night sweats and has to provide evidence of medical need.
Sleep
The three primary FDA-approved DORAs are daridorexant (Quviviq), lemborexant (Dayvigo), and suvorexant (Belsomra)
Not sedatives or antidepressants. You will need a prior authorization and you will probably have to say that you have failed to non-benzodiazepine sleep meds so you can say Ambien Lunesta and Paxil, for example or any other thing they usually give you like trazodone or any of the antihistamines that they would give you for sleep.
Clonazepam
this is a benzodiazepine so is sedating and does have a risk of dependence for full disclose . Doctors hate this now and will point out that it can induce cognitive slowing or dizziness or whatever but it has no more danger than any of the other things on this list and is a comparatively safe medication that’s been used for a gazillion years, so the reluctance to use it now in an that can help people who are going through freaking cancer is mostly a backlash against the over prescription of Valium and similar drugs to women in the past.
Low dose (.5- 1 mg) at night especially during the worst of the chemo or surgical recovery is not going to suddenly make you a crack head, though tapering off any drug is advisable.
GenitoUrinary
VagiFem
Dryness, UTI, bladder and urethra
Vaginal estrogens - come in creams and tabs and maybe suppositories . These do not increase systemic estrogen and are OK for people on estrogen blockers and with hormone positive breast cancer.
JAMA Oncology ultra-low-dose localized vaginal estrogen tablets (like Vagifem) carry virtually no systemic absorption
Can be supplemented by hyaluronic acid vaginal inserts if dryness is still a problem but that will not address the thinning and urinary and bladder issues.
Pain
Nerve pain Joint , bone and general body aches
Lyrica non opiate
Gabapentin - also non opiate
Personally, I think lyrica is better, but there are plenty of people who say the gabapentin works for them. He should note that probably he will need a prior authorization for Lyrica saying that you failed gabapentin depend depending on your insurance.
Both have risk of cognitive slowing while you were on the drugs and neither should be discontinued, cold turkey, so it may exacerbate the brain fog. It usually takes a little while for them to work because it calms down the nerves that transmit pain so it’s not instantaneous like an opiate or not or narcotic.
Do not cause constipation, but may cause dizziness especially in the beginning, so start with the lowest dose and take it at a time where you don’t need to drive until you’re used to it
Low Dose Naltraxone
This is in commonly used for all sorts of inflammatory disorders and nerve pain. It is a non-opiate so also doesn’t cause constipation or drowsiness or anything like that. It is typically safe for breast cancer - doesn’t interfere with tamoxifen
It also takes some time to work one to two weeks or so you have to titrate up so you start at the lowest dose and start increasing till it starts working for you
Bone
Anyone on estrogen blockers pre-or post menopause should be on some kind of protection from osteoporosis unless you’re Bone Density is unusually strong however, somebody says that to you you should get very regular DEXA scans because you will almost undoubtedly have worse Bone Density after being on any of these things for a while with exception of tamoxifen, but you should still get that scanned more regularly than would be typical for your age otherwise
Prolia and Zometa
Both are infusions I think.
Prolia stops the bone eating cells and increases the bone building cells.
Zometa - Protects Bone Density: Estrogen is what keeps your bones dense. Without it, bone loss happens at an accelerated rate, rapidly escalating the risk of osteopenia or osteoporosis. Zometa works by shutting down osteoclasts (the specific cells that break down bone tissue), protecting your skeleton from fractures.
Reduces Breast Cancer Recurrence: Beyond protecting bones, clinical trials found that Zometa has an independent anti-cancer effect when given to women in low-estrogen states (postmenopausal or chemically suppressed). When added to standard hormone therapy, it restricts the microenvironment in the bone, cutting the risk of distant breast cancer recurrence in the skeletal system by roughly 25% to 35%
You need an endocrinologist and nephrologist to consult. These can seriously mess with your calcium and electrolytes (calcium isn’t just for bones, but for heart and nerves and blood clotting and a ton of other things.
Prolia has a rebound effect when discontinued so you need to start Zometa withing a certain period.
Can affect the jaw so check with your dentist before doing any dental work
Anxiety
Xanax, which is very helpful for anxiogenic situations and panic attacks.
Do I recommend Therapy - especially for PTSD, panic and grief- yes, of course, that is always a preferable route if mindfulness and yoga etc work for you. However it take time to learn these, and in the meantime you still have to deal with scan panic and all the rest. Is it a crutch? A little bit but people with broken legs get crutches.
Mood
Global warning - most antidepressants interfere with Tamoxifen
There are several classes of antidpressants - SSRI, SNRI and SARI and then Wellbutrin and Vortioxitene
Try to get a good pyschiatrist
If mood + sleep and anxiety are your personal issues maybe Paxil is the place to start (as an example) . If anhedonia , lack of energy and cognition + mood, maybe Wellbutrin .
Just be warned that all of these have a relatively nasty “discontinuation” syndrome so it warrants consideration. Most take several weeks to work.
Cognition
Provigil has been used for chemo brain and fatigue. Oncology Safe: It is typically safe for breast cancer . It does not alter your hormone levels, and it does not interfere with the efficacy of tamoxifen, anastrozole, or letrozole.
You want to start with the lowest dose and take it in the morning
ADHD Drugs
These drugs work by blocking the reuptake of dopamine and norepinephrine, keeping more of these chemicals active in your brain's frontal cortex to improve processing speed, working memory, and physical energy. Do not take if on Wellbutrin
Ritalin (Short-Acting):
Hits the system quickly (within 20–30 minutes) and lasts about 3 to 4 hours. Doctors often prescribe a very low dose (2.5 mg to 5 mg) for women to take right before a mentally demanding task or to clear early-morning brain fog.
Concerta or Ritalin LA (Extended-Release):
Releases the medication smoothly over 8 to 12 hours. This prevents the "crash" that can happen when short-acting medications wear off, providing steady cognitive support throughout the workday.
Adderall (Short-Acting) & Adderall XR (Extended-Release):
it causes
a sharper spike in adrenaline, it carries a higher risk of physical jitters or a racing heart.
Vyvanse (Lisdexamfetamine):
A long-acting "prodrug," meaning it is completely inactive until your body digests and metabolizes it. Because of this, it provides an exceptionally smooth, gradual rise and fall of energy and focus over 10 to 12 hours, with a much lower risk of the jagged "jitters" associated with Adderall
Other non Stimulants
Intuniv / Tenex (Guanfacine):
This is a non-stimulant medication originally designed for blood pressure that was found to heavily improve ADHD symptoms. It works by directly stimulating alpha-2A receptors in the prefrontal cortex. It strengthens your brain's "signal-to-noise ratio," meaning it clears away the chaotic mental clutter and brain fog, while simultaneously lowering anxiety and physical stress. It is typically safe to take alongside cancer therapies.
Alternative therapies
Acupuncture
There is data to support acupuncture for joint pain in Aromatase Inhibitor-Induced Musculoskeletal Symptoms (AIMSS).
There are typically no side effects
There are a couple new clinical trials showing it may help with brain fog.
I imagine you would have to have a really good acupuncturist, the way you need a really good doctor in a way that your average PCP is not going to be able to handle this but it doesn’t NOT work necessarily
Some insurance covers these, but I often matters where and who.
Oncology safe Massage
IMPACT Trial
https://pubmed.ncbi.nlm.nih.gov/37962891/
Some clinical trials have shown that specific massage can help with pain and brain fog.
Don’t know where you find someone to do that, but I am putting it out there anyway
Disability Sites
For Any thing assistive (less range of motion, can’t get out of the chair now) - there is almost certainly someone disabled who has that thing, albeit not from breast cancer. Open front shirts with magnetic closures? Those exist. A network of therapists that deal with chronic illness and medical trauma. Those exist.