🌸 When Two Awareness Months Collide: Menopause, Breast Cancer & The Need for Inclusive Care

A calm middle-aged Black woman sitting indoors with her hand gently placed on her chest, eyes closed in reflection. The soft lighting and warm tones convey peace, strength, and emotional awareness, representing women navigating menopause and breast cancer recovery.

October is a significant month for women's health, marking both Menopause Awareness Month and Breast Cancer Awareness Month. While these topics often stand alone, for many women, these two conversations are tragically and intimately linked. When breast cancer treatment triggers a sudden, severe onset of menopause symptoms—often restricting the use of the most powerful treatment, Hormone Replacement Therapy (HRT)—women are left feeling isolated and underserved.

At Macvelly Wellness, we champion Inclusive Care and believe every woman deserves safe, personalized menopause care — including survivors.. This month, we're dedicated to shining a light on this specific journey and providing the evidence-based, non-hormonal, and lifestyle solutions needed to reclaim vitality and confidence during this double challenge.

The Complex Link: Treatment-Induced Menopause

It is crucial to understand that while menopause itself does not cause breast cancer, the hormonal therapies used to treat it can instantly induce menopausal symptoms.

Women who receive chemotherapy, ovarian suppression, or specific hormone-blocking drugs like Aromatase Inhibitors (AIs), often experience a rapid, severe decline in estrogen.

The Impact of Aromatase Inhibitors (AIs)

AIs are a cornerstone of treatment for many estrogen-receptor-positive breast cancer survivors. However, by effectively eliminating estrogen production, they frequently cause severe, treatment-limiting side effects that mimic and often exceed natural menopausal symptoms:

• Hot Flashes & Night Sweats: Highly common and often intense.

• Musculoskeletal Pain (Arthralgia): Severe joint and muscle aches, often in the hands, knees, and feet, are a leading reason why women prematurely stop taking this life-saving medication.

• Bone Density Loss: Accelerated bone loss, increasing the risk of osteoporosis.

• Insomnia and Fatigue.

• Vaginal dryness, pain with intimacy, and urinary discomfort

According to the North American Menopause Society (NAMS) and the American Cancer Society, up to 80% of women treated for breast cancer experience moderate to severe menopausal symptoms — yet fewer than half receive adequate support for symptom management.

⚖️ The Hormone Dilemma — and What the Research Says

Traditionally, hormone replacement therapy (HRT) has been avoided in women with a personal history of breast cancer. However, newer evidence underscores the importance of individualized decision-making rather than a one-size-fits-all approach.

While systemic estrogen therapy is generally contraindicated in hormone-receptor–positive breast cancer survivors, non-hormonal and localized options have emerged with strong safety data.

Because traditional HRT is contraindicated for most breast cancer survivors, the focus must immediately shift to powerful non-hormonal strategies.

Evidence-Based Non-Hormonal Solutions for Symptom Management

For breast cancer survivors navigating menopause, healthy lifestyle choices are far more than just symptom management—they are a critical component of the long-term survivorship plan, impacting both recurrence risk and overall well-being. The principles of Lifestyle Medicine offers powerful, evidence-backed tools to protect bone health, manage weight, and reduce fatigue.

The good news is that numerous non-hormonal and lifestyle interventions have strong evidence to mitigate these severe side effects.

Movement That Protects and Heals

Regular physical activity is recognized by major health organizations (like the American Cancer Society) as a proven strategy for improving outcomes for breast cancer survivors. It directly counters key treatment side effects and promotes longevity.

• Combating Bone Loss with Strength Training:

  • The Challenge: Estrogen depletion (due to natural menopause or cancer treatments like Aromatase Inhibitors) significantly accelerates bone loss, increasing the risk of osteoporosis and fractures.

  • The Evidence-Based Solution: Weight-bearing and resistance (strength) training are paramount. Studies consistently show that engaging in exercises like walking, jogging, lifting weights, or using resistance bands at least 2-3 times per week helps to build and maintain bone density. This is crucial for mitigating the skeletal side effects of hormone-blocking therapies.

  • Macvelly Strategy: We develop safe, progressive strength programs tailored to your physical capabilities and post-treatment recovery, focusing on functional movements that build bone and muscle without undue strain.

• Reducing Fatigue, Improving Mood & Energy with Aerobic Activity:

  • The Challenge: Cancer-related fatigue (CRF) and menopausal fatigue are often debilitating.

  • The Evidence-Based Solution: Aim for at least 150 minutes of moderate-intensity aerobic exercise per week (e.g., brisk walking, cycling, swimming). Research demonstrates that consistent aerobic activity can significantly reduce CRF, improve mood, enhance sleep quality, and support cardiovascular health, which is vital given that some cancer treatments can impact the heart.

• Alleviating Joint Pain (AIMSS):

  • The Challenge: Musculoskeletal pain, particularly arthralgia (joint aches and stiffness), is a common and often severe side effect of Aromatase Inhibitors (AI-induced musculoskeletal syndrome - AIMSS), leading to poor treatment adherence.

  • The Evidence-Based Solution: While challenging, gentle movement, stretching, and low-impact exercises like yoga or Pilates can improve flexibility and reduce stiffness. Additionally, consistent aerobic and strength training can help manage inflammation and overall pain.

Evidence-Based Medical Options (Beyond HRT)

While lifestyle changes are the foundation of inclusive care, women facing severe, treatment-limiting symptoms often need medical support. It is crucial for breast cancer survivors to discuss these non-hormonal, prescription-strength options with their oncology or medical team.

1. Non-Hormonal Medications for Vasomotor Symptoms (Hot Flashes)

These medications work on brain chemicals and neural pathways, not hormones, and have proven efficacy in reducing the severity and frequency of hot flashes:

• SNRIs and SSRIs (Antidepressants): Certain selective serotonin and norepinephrine reuptake inhibitors, particularly low-dose Venlafaxine (an SNRI), have strong evidence for reducing hot flashes. Other options like Paroxetine and Citalopram can also be effective. They are often prescribed at lower doses than those used for depression.

• Gabapentin: This medication, typically used for nerve pain and seizures, has been shown in clinical trials to reduce hot flash frequency, particularly when taken before bed, which also helps manage associated sleep disturbances.

• Oxybutynin: This drug, traditionally used for overactive bladder, has been found to be effective in reducing the frequency of hot flashes.

2. Specialized Treatments for Genitourinary Syndrome of Menopause (GSM)

GSM (formerly known as vaginal atrophy) is often severe in survivors taking Aromatase Inhibitors, causing chronic pain, dryness, and recurrent urinary issues. Since systemic estrogen is avoided, localized treatments are key:

• Vaginal Moisturizers and Lubricants: These over-the-counter products are considered first-line therapy. Moisturizers (used consistently, 2–3 times per week) hydrate the tissue, while lubricants (used during sexual activity) reduce friction and pain. Neither is absorbed systemically and they are safe for survivors.

• Vaginal DHEA (Prasterone): This is a low-dose suppository used inside the vagina. It is converted into local, active hormones, but studies show minimal systemic absorption. It can effectively treat GSM symptoms with little to no impact on blood estrogen levels, making it a viable option for many survivors, though it must be discussed thoroughly with an oncologist.

• Ospemifene: This oral prescription drug is a Selective Estrogen Receptor Modulator (SERM). It acts like estrogen on vaginal tissues to relieve dryness and painful intercourse (dyspareunia) but blocks estrogen effects in other parts of the body. It is often considered a safe and effective option for breast cancer survivors with persistent GSM, again requiring close medical guidance.

3. Cognitive Behavioral Therapy (CBT)

While CBT is not a pill, it is a structured, evidence-based psychological treatment that is often prescribed by physicians for menopausal symptoms:

• Impact on Sleep and Distress: CBT for menopause is highly effective. It helps women manage the distress and anxiety surrounding hot flashes and night sweats, which in turn reduces insomnia and improves overall quality of life, without altering hormone levels.

Nutrition for Long-Term Survivorship & Symptom Management

Diet plays a multifaceted role in managing menopausal symptoms and supporting long-term health for breast cancer survivors.

• Weight Management for Recurrence Risk:

  • The Challenge: Weight gain is common during menopause and post-cancer treatment. For breast cancer survivors, especially those with estrogen-receptor-positive cancer, maintaining a healthy weight after menopause is a critical factor in lowering the risk of cancer recurrence, as excess fat tissue can produce estrogen.

  • The Evidence-Based Solution: Focus on a whole-foods-based diet rich in vegetables, fruits, lean proteins, and healthy fats, with controlled portions.

• Macvelly Strategy: We craft sustainable, delicious, and personalized nutrition plans that prioritize metabolic health, support stable energy, and help achieve and maintain a healthy weight without restrictive dieting.

• The Power of a Plant-Forward Approach (e.g., Mediterranean Diet):

  • The Evidence-Based Solution: Research increasingly points to the benefits of a Mediterranean-style diet for cancer survivors. This eating pattern, rich in vegetables, fruits, whole grains, legumes, nuts, seeds, and olive oil, is associated with anti-inflammatory effects and may contribute to reduced recurrence risk and better overall health outcomes.

  • Symptom Mitigation: This diet's emphasis on whole, unprocessed foods also aids in gut health, blood sugar regulation, and provides a wide array of micronutrients, all of which contribute to better symptom management.

• Bone Health Support:

  • The Challenge: With accelerated bone loss, adequate calcium and Vitamin D intake are non-negotiable.

  • The Evidence-Based Solution: Ensure sufficient intake of dietary calcium (dairy products, fortified plant milks, leafy greens, fortified cereals) and Vitamin D (fatty fish, fortified foods). Supplementation may be necessary, and should be discussed with your healthcare provider, particularly for those on AIs.

Two women sitting together at a table, gently holding hands in a gesture of empathy and support. A coffee mug sits nearby, symbolizing warmth, connection, and meaningful conversation. The image conveys compassion, community, and healing among women navigating menopause and breast cancer journeys.

Empowering Your Advocacy and Next Steps

Navigating the intersection of breast cancer and menopause requires a commitment to self-advocacy and a willingness to seek out specialized support. The challenges of this journey—the rapid symptom onset, the limited treatment options, and the feeling of isolation—underscore the necessity of being your own best health advocate.

1. Tracking Symptoms is Power

The symptoms of medically induced menopause (like fatigue, brain fog, and joint pain) can often overlap with lingering side effects of cancer treatment. This makes tracking your health crucial for effective care.

• The Evidence-Based Approach: Keep a detailed, non-judgmental log of your symptoms, noting when they occur, their severity, and any potential triggers. This tangible evidence provides clarity and transforms vague complaints into actionable data points for your oncology and wellness teams.

• Advocacy in Action: When you go to your physician, you can present this data to advocate for tailored support, whether that involves adjusting an AI dosage or exploring non-hormonal prescription options.

2. Seeking Specialized, Inclusive Support

While your oncology team is focused on cancer survival, they may not always have the time or specialized training to address the complex, chronic symptoms of menopause with the non-hormonal expertise you require.

• The Gap in Care: Many women feel dismissed or told that their symptoms are an unavoidable trade-off for survival. This is simply not true. Every woman deserves to move past survival into a life of vitality.

• The Solution: Recognize that a personalized wellness coach or integrative practitioner who specializes in hormone health and cancer survivorship can bridge this gap. This coaching provides the education, support, and accountability needed to implement long-term lifestyle changes effectively.

The Need for Inclusive Menopause Care

The intersection of menopause and breast cancer highlights a larger issue — inclusivity in women’s health.
For too long, breast cancer survivors have been left out of menopause research and support programs, navigating life-altering symptoms alone.

If you are a breast cancer survivor experiencing menopausal symptoms from chemotherapy or hormonal therapy, you deserve compassionate, individualized care — care that is as targeted and empowering as your cancer treatment.
You are not meant to suffer in silence simply because hormone therapy is not an option.

At Macvelly Wellness, we specialize in creating personalized, evidence-based wellness roadmaps that succeed where hormone therapy cannot. We empower women to take control of their symptoms through strategic nutrition, mindful movement, stress management, and compassionate coaching.

Conclusion: A New Chapter of Wellness

This October, as we recognize both Menopause Awareness Month and Breast Cancer Awareness Month, let the collision of these two important conversations become a powerful call to action.

Menopause is not the end of vitality — it is a transition to a new chapter.
And breast cancer survivorship is a triumph — not a limitation.

Every woman, regardless of her history or background, deserves to experience clarity, confidence, and relief in midlife. Neither journey should require suffering in silence.

Your Next Step

By prioritizing inclusive, evidence-based care, educating ourselves on non-hormonal options, and advocating fiercely for our well-being, we can redefine the midlife experience together.

At Macvelly Wellness, we see you, we hear the complexity of your journey, and we are committed to helping you live a vibrant and confident post-treatment life.

✨ Ready to transform your symptoms into actionable wellness?
👉 Book a free discovery call with Macvelly Wellness today to find your personalized, non-hormonal roadmap to relief.
www.macvellywellness.com