- Question from Beth: I was thrown into menopause, due to an A/C regimen of chemo. I'm now on Arimidex and having hot flashes. Since my situation is not a 'natural' menopause, how long can I expect hot flashes to last? Duration of taking Arimidex for five years?
Mindy Goldman, M.D.
It's very common to be thrown into temporary or permanent menopause from the chemotherapy drugs used to treat breast cancer. Some of the hormonal drugs that we use to treat breast cancer can also cause menopausal side effects such as hot flashes, so that it's sometimes difficult to know if it's chemotherapy-induced menopause or side effects induced from hormonal drugs used.
Regardless, the symptoms tend to be the same. The primary complaint is hot flashes and night sweats. Often times, they're more severe than for women who go through natural menopause, because someone had previous normal ovarian function and then, "Boom!" They get put right into menopause. The length of time that women have hot flashes and night sweats varies incredibly. Some women don't experience it at all or have very few or mild symptoms, and for other women they're really disabling.
If you look at women who naturally go through menopause, more than 80 percent will have hot flashes in the first year. And by year three, they're decreasing in both frequency and intensity. And only about 15 percent of women will have hot flashes throughout their menopausal years. With chemotherapy-induced menopause, we don't have a good handle on the natural course, because many times we don't know if it's permanent or temporary menopause.
What I mean by that is when someone gets chemotherapy, it depends on the age of the patient, the type of chemotherapy, and the dose that's given that determines whether their menopause is temporary or permanent. Also, some of the hormonal drugs can affect whether someone gets a period. So it's possible that someone can actually be coming out of the chemotherapy-induced menopause but persists in having hot flashes as a side effect of drugs like tamoxifen or Arimidex (chemical name: anastrozole).
- Marisa C. Weiss, M.D. Also interesting, sometimes a woman who was thrown into menopause early just from chemotherapy and who notices eventual improvement in hot flashes may be having return of a period. That is, sometimes when your hot flashes ease up, it may be a sign that you will have return of your period. During the time of uncertainty relative to being in a temporary or permanent menopause, be sure to use birth control if you are sexually active.
Mindy Goldman, M.D.
If you look at drugs like tamoxifen, 25-50 percent of women will complain of hot flashes, but they tend to get better with the longer length of time being on tamoxifen. There are also some reports from women who were post-menopausal before they got their breast cancer and their breast cancer drugs, that if they had an easy time with menopause, they tend to have an easy time with side effects from drugs like tamoxifen and Arimidex.
Because the aromatase inhibitors, including Arimidex, haven't been used as long as tamoxifen, we don't have a good handle on how long the hot flashes should last. We do have reports that there tend to be fewer complaints of hot flashes on the aromatase inhibitors compared to tamoxifen. But, again, we can't give someone a prediction as to how long they will continue.
- Marisa C. Weiss, M.D. It's important to recognize that the aromatase inhibitors are only used and effective in post-menopausal women.
On Wednesday, July 21, 2004, our Ask-the-Expert Online Conference was called Managing Menopausal Symptoms. Mindy Goldman, M.D. and Marisa Weiss, M.D. answered your questions about how to manage menopausal symptoms, including hot flashes, vaginal dryness, loss of libido, and more.
The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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