Managing menopausal side effects is more important than ever, as it affects the quality of life in cancer “thrivership.” Many women and men face years of side effects from cancer treatment resulting from the surgical removal of ovaries and hormone deprivation therapy (tamoxifen, aromatase inhibitors, etc.) in hormone receptor-positive cancers such as breast, endometrial, ovarian and prostate.

Side effects of hormonal cancer therapies

The most common symptoms from hormonal cancer therapies are hot flashes, night sweats, insomnia, and weight and libido changes. Long-term side effects from these therapies include bone loss, heart disease, depression and mood changes, and skin and muscle mass changes. With improved cancer therapy options, there are fortunately more patients entering into survivorship, but also more who now have to grapple with these side effects for years to come. Add in menopause symptoms and it can be overwhelming.

Utilizing hormone replacement therapy (HRT) is controversial and typically contraindicated for cancer survivors, even in hormone receptor-negative breast cancers. However, other non-hormonal approaches are being studied and utilized for their traditional relief of menopausal symptoms.

Plant-based therapies can offer much-needed relief. The following herbs have phytoestrogenic properties and have been studied for their ability to reduce hot flashes and other menopausal symptoms. Phytoestrogens are compounds made by plants that are similar to, but not the same as, the hormones made in our bodies. Phytoestrogenic plants such as soy food (not the highly processed frozen meat substitutes or soy isolates such as genistein) are beneficial in reducing cancer incidence and generally are safe for cancer survivors.

Black cohosh

Black cohosh is a traditional herb used to treat menopausal symptoms. In four German clinical trials and meta-analyses, black cohosh was shown to effectively reduce hot flashes. In a recent systemic review, it was shown to be safe in breast cancer survivors, and intake did not elevate their hormone levels or disrupt their hormone-blocking medications.

Sage

Sage (salvia officinalis) is a well-known herb with a multitude of healing properties. In a 2019 and 2020 randomized controlled trial, sage was shown to significantly reduce hot flashes, night sweats, anxiety, insomnia and fatigue. A 2021 pilot study showed that sage reduced hot flashes in prostate cancer patients on androgen deprivation therapy (ADT) without interfering with the ADT medications.

Flaxseed

Flaxseed can be found in nearly every grocery or health food store. It is high in lignans which are phytoestrogens and also has one of the highest plant sources of omega-3 fatty acids, which are anti-inflammatory fats that help reduce cholesterol. Flaxseed has also been shown in clinical trials to reduce mild symptoms of menopause, reduce breast tumor growth (mainly in postmenopausal women), and reduce the incidence of estrogen receptor-negative cancers. The recommended dose is two to three tablespoons of fresh ground flaxseed daily.

Melatonin

Insomnia is one of the most common side effects of menopause and many other conditions. Sleep deprivation has many negative side effects, which is why melatonin is such a crucial aid. Melatonin is not an herb; it is an important hormone that regulates your sleep-wake cycle (circadian rhythm) produced by the pineal gland in your brain when it is dark. Melatonin not only has powerful properties for inducing sleep, but also has strong immune, antioxidant and anti-cancer properties. It has been found to be neuroprotective and restore cognitive function during chemotherapy and has also been shown to inhibit triple-negative breast cancer proliferation and suppress breast cancer stem cells.

Exercise is king

Let us not forget the importance of exercise! Exercise has been shown to improve cardiovascular health, reduce bone loss, maintain healthy weight, improve mood, reduce stress, improve sleep, and reduce cancer recurrence. In a 2019 study, resistance exercises of 45 minutes, three times a week, cut hot flashes by almost half! There is no excuse to forgo exercise!

Supplements need to be monitored

Patients need to be monitored by their health care team and should consult an appropriate health practitioner before starting any medication, including herbs and supplements. Even though they are not prescription medication, herbs can have a powerful effect on your body and can interact with other medications.

Dr. Sonja Fung is a primary care naturopathic doctor with a focus on integrative cancer care and PRP regenerative joint injections at Live Well Clinic in La Quinta. For more information, visit www.livewellclinic.org or on Instagram @livewellclinic.

Sources available upon request.