Surviving and thriving with metastatic breast cancer

Linda Mihalov, MD, a Fred Hutch/UW gynecologist and certified menopause practitioner, spoke about the profound impact of breast cancer on sexual health.

Most breast cancers are ER+, meaning estrogen-suppressing medications are an important part of treatment. Unfortunately, the loss of estrogen causes a host of side effects: hot flashes, night sweats, urgency and frequency of urination, irritation of the vaginal tissue, vaginal dryness and loss of elasticity, and, as a result, pain during sex.

“Estrogen promotes healthy tissue and the absence of estrogen causes all these symptoms,” she said. “Symptoms may develop even more rapidly with an abrupt drop in estrogen levels due to chemotherapy, endocrine therapy or removal of the ovaries.”

Fortunately, there are therapies that can help reduce these symptoms. Mihalov said it’s important to use a vaginal moisturizer daily, even if you’re not sexually active.

“You would use it regularly, just like you moisturize your skin,” she said. “This can help with vaginal dryness and bladder problems. And coconut oil is fine.”

Lubrication is also critical for those who have vaginal intercourse (if it’s been a while, dilaters can help prepare you). Vaginal estrogen — via cream, tablets or vaginal ring — is the most effective treatment, she said, and most oncologists believe it is safe, even for breast cancer patients.

“The vagina is the only organ in the body that can age backward,” she says. “If you give a vagina estrogen, it looks younger and the estrogen does not enter the bloodstream. But you should always check with your oncologist about using estrogen.

Fred Hutch mental health doctor Rae Wiseman spoke about the importance of mental health, whether that comes from a belief in a higher power, belief in yourself (or in others, such as your medical team), or a love of nature.

“All of these paths to faith are important and can give us a sense of peace as we go through life’s challenges,” she said. “When it comes to finding your spirituality, some people are traditionally religious, but many of us take it in pieces. It is wherever you find meaning and connection – whether that is in the garden, while being in nature, while making art, or spending time with your children or grandchildren.”

Finding meaning in life won’t just help you get through the bad days. Wiseman said research shows that people with a sense of purpose have it a 30% higher survival rate.

“Clear the way for spiritual connection,” she said. “Be open to awe and wonder. Be part of something bigger, like a clinical trial. Love and accept yourself as much as possible. The more you take care of yourself, the more you can radiate love, kindness and compassion for others.”