(28) Life after Breast Cancer

I am too stressed for sex. How can I manage my stress better?

Stress management is a learned skill. Although much stress is out of your control, how you organize yourself to respond to stress will directly relate to your quality of life. Stress can change your hormones and ultimately your sexual response. Women who suffer from severe and chronic stress often complain of decreased sexual interest. They may be uninterested in sex and often shun advances from their partners. The following suggestions offer methods you can use to manage your time and thought processes:

Revise your thinking. Acknowledge frustration. Accept the things you cannot change. Forgive. Consider whether there might be more positive solutions to the problem. Take a break when needed. Sometimes the solution is staring you in the face-you might need only a short cooling period to discover the best action. Start at one place, and try to do what you can. Know your limits.

Choose a healthy diet and exercise regimen. Following a diet rich in fruits, grains, and vegetables while decreasing saturated fats tends to lower your blood pressure. Limit caffeinated drinks because they can increase anxiety and cause rapid heart rates. Choose healthy, low-calorie snack foods. Your energy will return after eating a nutritious diet. Eat a diet that is rich in antioxidants, including strawberries, blueberries, and raspberries. Juice plus, a food supplement of fruits and vegetables, can help to energize the immune system. Preliminary research shows that women (and men and children) on Juice plus have increased levels of antioxidants, which can fight free radicals. Those who take Juice plus often tell of decreased fatigue, boosted immunity, and overall health and wellness. It is food and many women and men swear by its effectiveness. It has anti-inflammatory properties and is widely researched in many prominent universities. Exercise away your stress. Often a brisk walk or a session at the gym will help clear your mind so that you can reframe your problems more creatively and manageably.

Plan. Stay focused and organized. If you plan your day in advance, you are more likely to spend your time efficiently. Be sure to leave work at your designated time, delegate chores to family members (including children), or (if financially possible) hire extra housecleaning help. Your spouse or partner can always pitch in to get the dry cleaning, shop for food, or help the children do their homework. Divide and conquer household tasks.

Know and set your limits. Is it really crucial that your bed be made every day? Is it okay to have some clothes on the floor once in a while? Choose not to get overly stressed if your home is not clean. Make active decisions to delay certain chores.

Say no! Overextending yourself leads to increased stress and anxiety. Learning to say no, at appropriate times, to personal, social, or employment commitments is crucial. Be polite, yet firm, in your convictions. By saying no to certain projects, you remain focused on the activities that are most important. With practice, learning to say no becomes increasingly easier. You cannot be everything for everyone.

Relaxation techniques. Meditation, yoga, or other relaxation techniques provide useful tools to help maintain an active lifestyle with a sense of tranquility. Stretching and Tai Chi classes are often offered inexpensively at your neighborhood YMCA or recreation center. Practice deep breathing for 5 to 10 minutes at a time. Try to clear your mind of all thoughts and concerns and just focus on your breath. Relax your muscles as you inhale and exhale, while letting your mind go completely blank. This exercise is a great stress buster early in the morning or late at night.

Many other therapeutic strategies are available. Professional counseling with a trained social worker, psychologist, or psychiatrist may help you work through unresolved childhood issues. Emotional patterns and responses to serious life events can emerge from the subconscious to the fully conscious adult in a safe way for healing. Getting a perspective from a professional therapist often opens new avenues of thinking about your situation. They specialize in helping you to develop coping strategies tailored to meet your emotional needs.

Magnolia Myrick:

Breathing, focusing on the breath, is as simple a form of meditation as there is, and as effective. Everything I read and hear about meditation says it is good and good for you. What do you have to lose? I have meditated off and on since college, but I do it regularly now, and without fail. It is a little effort with a big benefit. Wayne Dyer’s Getting in the Gap is a good, easy, and short how-to on meditating, but there are lots of books out there on meditation. Transcendental meditation is also an excellent and easy method learned in several hours of formal instruction, for which there is a fee. For more information, transcendental medication’s nonprofit organization has a very good website. It is the first kind of meditation I learned and a fool-proof technique I can practice anytime, anywhere.

How do Tamoxifen (AstraZeneca) and aromatase inhibitors affect sexual function?

Tamoxifen, manufactured by AstraZeneca, is a selective estrogen receptor modulator (SERM) that is often used to treat breast cancer and can exacerbate menopausal symptoms. SERMs have been linked with vaginal dryness, vaginal discharge, vaginal tenderness, changes in orgasm, and diminished libido. Studies examining the effects of Tamoxifen on sexual functioning in women are conflicting and inconclusive. The Breast Cancer Prevention Trial states that minor differences in sexual functioning were observed in Tamoxifen users. In contrast, Mortimer’s study demonstrated no changes in any phase of female sexual response cycle for women who were taking Tamoxifen. Femara (Letrozole) (Novartis oncology), Arimidex Anastrozole (AstraZeneca), and Aromasin Exemestane (Pfizer Pharmacology) are all aromatase inhibitors.

These medications work by blocking the conversion of testosterone to estrogen and significantly lowering the levels of circulating estradiol. Although this action is often the objective of breast cancer therapy, they can aggravate menopausal symptoms and cause osteopenia, osteoporosis, arthralgia, decreased vaginal lubrication, vaginal dryness, and painful intercourse. Many women even discontinue their medications because of distressing and troublesome vaginal dryness and painful sex. More scientific trials are needed to address the sexual ramifications of these drugs.

Many of the pharmaceutical companies are now becoming more actively involved in survivorship concerns, and sexuality is high on their radar screens. Survivorship initiatives are underway to help mitigate side effects while effectively managing the disease state.

My depression medication is hurting my sex drive. I feel sad and am crying a lot. How can I get a handle on my depression?

Throughout your journey with cancer, it is normal to feel anxious or depressed, as you may believe that you have lost a vital part of yourself and are worried about the future. When sadness persists and is combined with feelings of helplessness or hopelessness, a loss of or increased appetite, and sleep disturbances, a diagnosis of major depression may be considered. When your emotions interfere with your life, you are careless of your hygiene, you lack a zest for life, or you withdraw from social and professional commitments, it is time to seek professional help. If you find yourself making plans to hurt yourself or even think about ending your life, seek immediate medical attention. Today, depression is not seen as a sign of weakness or stigma-rather, it is a known and accepted neurobiological condition. Depression can be treated effectively with both medications and psychotherapy.

Often, successful management might include a prescription of antidepressant medications combined with psychotherapy. The cause(s) of a major depression is often multifaceted, and thus, a multidimensional approach is required for effective treatment. Biological, psychological, and social factors are often addressed during therapy sessions. Individual counseling therapy involves visiting with a therapist alone. Group therapy is when a small number of people meet with a therapist together. Because some women find comfort in talking with other women ho have undergone the same treatments or suffer from the same type of cancer, group therapy may be helpful. Cognitive behavioral therapy, interpersonal therapy, supportive psychotherapy, and psychodynamic psychotherapy are different programs that you may consider when talking with your therapist(s). Many national cancer centers have post treatment resource centers or survivorship programs that organize group support programs for both men and women, and sometimes they are cancer diagnosis specific. Other program events can include discussions about depression, sexual health, or other survivorship issues. Sharing your concerns and fears with others may be a way to help you regain control over your emotions.

Antidepressant medications can cause sexual side effects. The serotonin retake inhibitors often affect sexual interest, libido, or orgasm. An orgasm maybe less intense or the time to orgasm may be affected by your antidepressant medication. If you are having sexual side effects from your depression medication, discuss your concerns with your sexual healthcare provider. Sometimes switching medications can be helpful. Reassess whether you actually need to take the medication. Others plan sexual play when medications may be least offensive. If you take medications in the morning, plan sexual play in the morning before your next dose. In some recent studies, the addition a PDE5 inhibitor taken before sexual activity has been shown to be helpful for reversing or lessening serotonin retake inhibitor-induced sexual side effects. Before trying an antidote or switching your medications, consult with your healthcare team.

Terms:

Free radicals – An atom or group of atoms that has at least one unpaired electron and is therefore unstable and highly reactive. It typically can cause damage to normal cells.

Letrozole – An antiestrogen type of medication in the class of aromatase inhibitors. It inhibits the conversion of testosterone to estrogen.

Aromatase inhibitors – Drugs that suppress the body’s natural production of estrogen by reducing production of the enzyme aromatase.

Testosterone – A sexual hormone produced in the ovaries and adrenal glands. It is important in normal sexual functioning. It has been implicated in normal female libido or desire.

Osteopenia – A condition characterized by bone loss.

Osteoporosis – A condition characterized by decrease in bone mass and density of the bones, resulting in “thinning” of the bones, causing them to become more fragile.

Arthralgia – Joint muscle discomfort.

PDE 5 inhibitor – Class of drugs which cause smooth muscle relaxation. Typically used in men and have been used effectively for the treatment of erectile difficulties.

Today, depression is not seen as a sign of weakness or stigma-rather, it is a known and accepted neurobiological condition.