Vaginal dryness, loss of libido, and pain during sex are some of the most common sexual side effects of hormonal therapy to treat hormone-receptor-positive breast cancer. These side effects often lead to lower overall quality of life among women who’ve been diagnosed. Still, a small study suggests that postmenopausal women with partners may have better quality of life than women without partners when experiencing a number of sexual side effects from breast cancer hormonal therapy.
The research was published online on April 15, 2019, by the journal Menopause. Read the abstract of “Partner status moderates the relationships between sexual problems and self-efficacy for managing sexual problems and psychosocial quality-of-life for postmenopausal breast cancer survivors taking adjuvant endocrine therapy.”
Doctors call treatments given after breast cancer surgery adjuvant treatments.
How do hormonal therapy medicines work?
Hormonal therapy medicines can be used to:
- lower the risk of early-stage hormone-receptor-positive breast cancer coming back
- lower the risk of hormone-receptor-positive breast cancer in women who are at high risk but haven't been diagnosed with breast cancer
- help shrink or slow the growth of advanced-stage or metastatic hormone-receptor-positive breast cancers
Hormonal therapy medicines work by:
- lowering the amount of estrogen in the body
- blocking the action of estrogen on breast cancer cells
There are several types of hormonal therapy medicines. Tamoxifen, a selective estrogen receptor modulator (SERM), is one of the most well-known. Tamoxifen can be used to treat both premenopausal and postmenopausal women.
In the early 2000s, the aromatase inhibitors:
- Arimidex (chemical name: anastrozole)
- Aromasin (chemical name: exemestane)
- Femara (chemical name: letrozole)
were shown to be more effective at reducing recurrence risk in postmenopausal women and are now used more often than tamoxifen to treat women who’ve gone through menopause. Aromatase inhibitors aren’t commonly used to reduce recurrence risk in premenopausal women, but they can be in certain cases.
Side effects of hormonal therapy
The most common side effects of tamoxifen are:
- hot flashes
- night sweats
- vaginal discharge
- vaginal dryness
- mood swings
Tamoxifen also may contribute to a loss of libido or a decreased interest in sex.
Aromatase inhibitors also may cause vaginal dryness and fatigue. The most common side effects of aromatase inhibitors are:
- joint pain and stiffness
- hot flashes
How this study was done
Earlier research suggests that more than 90% of women taking hormonal therapy after breast cancer surgery have sexual function side effects, including vaginal dryness, loss of libido, and pain during sex. Still, not much research has looked at how these sexual problems affect quality of life.
The researchers who did this study wanted to know how sexual problems and a woman’s ability to cope with these problems affected her quality of life. They also wanted to find out whether having a partner or not affected a woman’s ability to cope with any sexual problems, which then influenced her quality of life.
The study included 112 postmenopausal women diagnosed with stage I to stage IIIA hormone-receptor-positive breast cancer. All the women had completed surgery, chemotherapy, and/or radiation therapy treatment and were taking hormonal therapy. All the women were treated at a medical center in North Carolina.
Among the women in the study:
- ages ranged from 45 to 84; average age was 63.66
- 81.3% were white
- 68.8% were living with an intimate partner
- of the women living with an intimate partner, 96.1% were married to their partner
- 28.6% had a college degree
- 61.6% were diagnosed with stage II or stage III breast cancer
- 52.7% were treated with chemotherapy
- 75.0% were treated with radiation
- 17.9% were taking tamoxifen
- 82.1% were taking an aromatase inhibitor
- average time the women were on hormonal therapy when the study was done was slightly more than 2 years
The women completed a standard questionnaire used to measure menopause-specific quality of life, called MENQOL. The questionnaire asked about sexual problems they might have had in the last month, including:
- loss of libido
- vaginal dryness
- pain during sex
- avoiding sex or intimacy
If a woman reported that she was having a sexual problem, she was asked how bothered she was by that symptom.
The women also were asked how confident they were in their ability to cope with sexual problems.
Nearly 70% of the women reported at least one sexual problem, and nearly 40% said they were not at all or only a little bit satisfied with their sex life:
- 57.1% of the women reported decreased sexual desire
- 56.3% reported vaginal dryness
- 40.2% reported they were avoiding intimacy
On average, the women were only somewhat confident in their ability to manage sexual problems.
Overall, the researchers found that older women and women who were not treated with chemotherapy were more satisfied with their sex lives.
Women who reported more sexual problems had lower quality of life. Women living with a partner reported more sexual problems than women who didn’t live with a partner.
Still, when looking at only women who reported a high number of sexual problems, women who did not have a partner had poorer quality of life than women who had partners.
The researchers also found that a woman’s confidence in her ability to cope with sexual problems didn’t seem to affect quality of life for women with partners. However, if a woman didn’t have a partner, the less confident she was in her ability to cope with sexual problems, the poorer her quality of life.
“Our findings suggest that being unpartnered may exacerbate the impact of sexual problems and poor sexual self-efficacy on psychosocial quality-of-life for postmenopausal breast cancer survivors receiving [hormonal therapy],” the researchers wrote. “Given the high prevalence of sexual problems among postmenopausal women receiving [hormonal therapy] and the long treatment course (5-10 years), it is important to understand factors that may impact women’s quality-of-life and identify points for intervention.”
What this means for you
If you’re taking tamoxifen or an aromatase inhibitor and are having sexual problems, don’t suffer in silence. There are treatment options available. This study suggests that many women report sexual problems while taking hormonal therapy, whether they have a partner or not.
Research has shown that a specific type of online counseling therapy, called internet based cognitive behavioral therapy, can help improve sexual function, body image, and menopausal symptoms in women who’ve been treated for breast cancer.
In February 2018, the American Society of Clinical Oncology issued guidelines on treating sexual problems in people diagnosed with cancer, including counseling and medicine.
According to Lynn Wang, M.D., a female sexual medicine specialist and member of the Breastcancer.org Professional Advisory Board, a good place to start is your gynecologist. Although gynecologists are not specifically trained to address sexual issues, your gynecologist can check for biological causes of certain symptoms, such as vaginal dryness, and treat it. Then you can ask for a referral to a sex therapist or sex counselor. To find a certified sex counselor in your area, visit AASECT.org, the website of the American Association of Sex Educators, Counselors, and Therapists.
To talk with others about how breast cancer and its treatment has affected your sex life, join the Breastcancer.org Discussion Board forum Sex & Relationship Matters.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser