Aromatase Inhibitors in Sexual Health

Following on from last week's blog post, a number of my patients with breast cancer brought up concerns about their treatment-induced symptoms. So let's talk about it a little more.

Endocrine therapy side effects: It's not just survival that matters.

I think we can all agree that Endocrine Therapy is useful for many breast cancer survivors: The American Society of Clinical Oncology (ASCO) recently confirmed that although endocrine therapy doesn't affect overall survival in breast cancer survivors, it does significantly reduce risk of recurrence and should be recommended for 5 years (node negative patients) or up to 10 years (node positive patients).

The problems with AI's

No, I'm not talking about Artificial Intelligence, I'm talking about Aromatase Inhibitors. Aromatase Inhibitors (AI's) are a group of anti-oestrogen therapies prescribed by Medical Oncologists for the treatment of patients who have experienced hormone-sensitive cancers. The proposed treatment duration is typically 5-10 years.

Unfortunately, these group of medications can have significant side effects including the following, which roughly fall into these four main categories:

Sexual/genitourinary changes: low (no) libido, vaginal dryness, painful intercourse, vulval itching, recurrent UTI's, urinary frequency
Central Nervous system changes: anxiety, depression, cognition changes, migraine,  sleep disturbance
Musculoskeletal symptoms: joint pain, osteoarthritis, osteoporosis
Metabolic changes: weight gain, increased belly fat, hair loss, reduced skin elasticity and hydration.

And you're more likely to experience these symptoms if you are a 'oestrogen responsive' genotype. These side effects are clearly a big issue, considering that recent research has shown that 17% of Australian AI patients discontinue treatment by the end of the first year and 58% have discontinued at the 5-year mark.

There are many Complementary Medicines that can reduce some of these side effects. We have plenty of evidence-based options to reduce joint pain, weight gain, cognition changes, mood and sleep changes. Speak to your Integrative Oncology specialist about this. 
But my experience is that there are some issues that are a little harder to 'treat'.

 

So let's talk about sex... What's that again?

Vaginal dryness and painful intercourse can be very difficult to manage, which is one of the reasons why up to a quarter of partnered cancer survivors are not sexually active (you know, in addition to the intense tiredness and libido that has been chemically switched off). Severe vaginal atrophy occurs in 33% of AI users compared with around 6% of Tamoxifen users. And with AI's, unfortunately the urogenital symptoms increase over time. Remedies that don't work include vaginal 'rejuvenation' laser treatment, vaginal moisturisers or herbal douches.  Silicone lubricant is better than water based for enhancing the sexual experience, and some research even recommends an anaesthetic gel (great in theory but not popular with the ladies we'd rather feel something thanks), but after cancer we do know that we definitely need more cuddles and more of a physical 'warm up' before sex.

Always see your GP if recurrent infections/burning/itching occur as some infections and other causes may be contributing.

And don't be scared to have a conversation with your Medical Oncologist: there are a number of options to the textbook care that have come out of recent medical research, including the following:

• Recent research has also shown that a 'summer holiday' away from AI's does not necessarily reduce long term effectiveness: a 3-month summer break is ok (yay say all of the permanent-fan-holding flushing ladies)
• Each of the antioestrogens has a slightly different side effect profile, so a change of medication could be considered by the Oncologist and may do the trick.
• Low dose vaginal oestrogen creams can also provide some local tissue relief without increasing body levels of oestrogen in the breast.

MIOG offers individualised care during treatment for patients with cancer, as well as multiple survivorship support resources including nutritional, psychology, acupuncture and massage therapies. Call us for a chat! +613 9571 7498