One Size Does Not Fit All for Solving Menopause Problems

From the WebMD Archives

July 14, 2000 -- When Gloria Moore was diagnosed with breast cancer four years ago, not only did she have to undergo treatment for the disease, but she also had to give up the hormone replacement therapy she had been using to control her menopausal symptoms.

"I was having severe hot flashes," the 57-year-old Moore tells WebMD. "They were so severe, I couldn't function. I couldn't sleep; it was covers on and off all night. I had severe perspiration; at staff meetings at work I would be fanning myself, taking off layers of clothes, and leaving. It was just unbearable."

Moore says she tried a number of different approaches, including herbal remedies, without luck. Desperate, she signed up for a study at UCLA that looked into how to manage menopausal symptoms in breast cancer survivors. During that study, she found the help she needed. For her hot flashes, she was put back on one of the drugs she had originally tried (Megace), but on a different dose, and for what she calls "the trauma, the devastation of having breast cancer," she was referred to individual therapy.

"It really helped. My entire quality of life improved with the Megace because I was able to function again -- before, I was a total basket case," says Moore "And with the therapist, when that began, I felt a tremendous improvement; I felt I got my life back."

The UCLA study Moore and 75 other post-menopausal breast cancer survivors joined was initiated to test how effective a specially designed intervention program was at helping women cope with certain problems associated with menopause.

At the start of the study, all of the women were experiencing severe cases of at least one of three common menopausal symptoms: hot flashes, vaginal dryness, and/or urinary incontinence.

Typically, women are given hormone replacement therapy to control those symptoms, but because Moore and the other patients had had breast cancer, they weren't eligible for the drugs. "There are theoretical concerns that estrogen may promote or stimulate the growth of new tumors, and a lot of women who have had breast cancer are very concerned about taking estrogen," Laura Zibecchi, RN, NP, MSN, tells WebMD. "Our goal was to develop an intervention program that would address multiple menopausal symptoms in breast cancer survivors. What we wanted to do was hopefully relieve symptoms and improve quality of life ... we developed a 'menu' of options of non-estrogen alternatives."

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Half of the women in the study participated in the intervention program, the other half received "usual care" -- which means that, after the initial medical exam, they were not provided with information or advice on how to control their symptoms.

Zibecchi, a clinical research nurse practitioner in the division of cancer prevention and control research at UCLA, was the nurse practitioner who advised and cared for the patients assigned to participate in the intervention program.

"Everything was individualized to the individual patient -- so we didn't really offer a one-size fits all [approach]," Zibecchi explains. "We went into a very detailed assessment of their particular symptoms and the factors that affect [them]."

The study results show that after four months, the women who entered the intervention program reported more improvements in their symptoms and in sexual function than the women who received "usual care," although general quality-of-life scores were about the same in the two groups.

"There are many women who don't want to discuss these symptoms with health care providers because they are so private and personal. I think that if health care providers don't have a systematic, comprehensive approach, they may miss women who have these symptoms, and the women will go on and suffer needlessly," says Zibecchi.

Zibecchi adds that some women want information, but there is nobody there to give it to them. "They are searching the Internet, and they are going to the lay literature, and they are trying things that are not safe or effective for their symptoms."

"It is important women be asked about these symptoms and also to be fully informed about their options and be encouraged to participate in the decisions surrounding what they want to do about their symptoms," says Zibecchi.

"I didn't want [breast cancer] to conquer me, but the quality of life wasn't there," says Moore. "I enjoy life now; I don't think I would, had it not been for UCLA."

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