EMW10 (Jessica)

Name: Yen-Yi
Age at interview: 41
Diagnosis: Menopausal symptoms as a result of hormone (adjuvant endocrine) therapy
Age at diagnosis: 37

Background: Yen-Yi works part-time in the finance sector. She lives with her sister in a metropolitan city and is from a Chinese background.

About Yen-Yi: Yen-Yi was 37 when she was diagnosed with hormone sensitive breast cancer. Her treatment involved a lumpectomy, chemotherapy, radiotherapy, and endocrine therapy. Yen-Yi’s periods stopped during chemotherapy and she began experiencing hot flushes during radiotherapy. Following endocrine therapy, she has experienced hot flushes, disturbed sleep, fatigue, and loss of cognitive function. Family and work-related challenges in combination with menopausal symptoms led Yen-Yi to experience depression, however counselling and antidepressant medication have been helpful.

More about Yen-Yi: Yen-Yi was diagnosed with hormone positive breast cancer at age 37, and underwent a lumpectomy, chemotherapy, radiotherapy, and hormone (adjuvant endocrine) therapy. Before chemotherapy, Yen-Yi was referred to a fertility specialist, but decided not to pursue fertility preservation as did not wish to have children. She recalled thinking then that cancer treatment would affect her menstrual cycle in the short term only, and that after a year her body would ‘pop right back into place.’

Although Yen-Yi had expected her menstrual periods might stop during chemotherapy, the ‘heatwaves’ she experienced during radiotherapy were a surprise. Concerned, she spoke to her radiation oncologist, who ‘glibly’ advised her that these were ‘probably’ hot flushes. It was not until Yen-Yi began taking anti-oestrogen medication (tamoxifen) that she recalled menopausal symptoms being mentioned. However, because ‘no-one had really set out clearly’ all the effects of treatment, she remained uncertain about the causes of her various symptoms and worried that she was ‘failing the treatment.’

In contrast, when Yen-Yi changed from tamoxifen to exemestane and monthly goserelin injections to induce ovarian suppression, she was told this would mean experiencing a ‘temporary’ menopause for five or 10 years, depending on the length of her treatment. However, ‘no-one quite knew’ if her periods would return afterwards.

Yen-Yi’s menopausal symptoms have included hot flushes, ‘fluctuating’ moods, facial hair, vaginal dryness, and sleep difficulties. Disrupted sleep due to hot flushes was ‘distressing,’ the resultant fatigue affecting her cognitive ability and, in turn, her self-confidence. Over time, Yen-Yi began experiencing depression, which she attributed to her symptoms as well as stress related to an unsupportive workplace and her sister being diagnosed with cancer.

To manage her menopausal symptoms and improve her bone strength, Yen-Yi has started exercising regularly, and takes a vitamin D and calcium supplement. To help with sleep and mood, she practices sleep hygiene and relaxation techniques, sees a counsellor, and takes antidepressants. Yen-Yi also wears layers so she can ‘peel them off easily,’ and a hat when outdoors.

Yen-Yi has only told her family and close friends about her menopausal symptoms. While her symptoms have eased, she thinks it will be some time before she can be ‘reconciled’ with her experience of menopause. Yen-Yi believes there could be better information for younger women facing premature menopause following cancer treatment, to save them the ‘emotional distress’ of ‘wondering’ about their symptoms, but reassured other women in her situation that they are not alone and that ‘there’s always help.’