Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat:

I am 45 and have several serious problems.  I was diagnosed with early stage breast cancer at 41, even though I had no family history and the genetic test, BRCA, was negative. My breast cancer was found on a mammogram and could not be located on physical exam at all.  I had a lumpectomy, radiation treatment, and then tamoxifen, which I was told to take for 10 years. I was grateful for the early detection.

Three years later I developed endometrial cancer. It was found early because my gynecologist told me that since tamoxifen is associated with an increase in endometrial cancer, I should have a yearly sonogram.  Once the sonogram showed an increase in thickness of the endometrium, I had a biopsy, which found endometrial cancer.  I was “lucky” again, since the very small amount of endometrial cancer was confined to the uterine cavity and was Stage 1. A total hysterectomy with removal of my tubes and ovaries was all I needed. The tamoxifen was discontinued and I was begun on another drug to prevent breast cancer recurrence.

It is now one year after this surgical menopause and I am having a hard time with hot flashes and night sweats.  I was always an upbeat person, and in spite of all that has happened to me, I am still optimistic. However, I am a little gun-shy of taking more drugs to help with these symptoms, after my experience with tamoxifen, but I certainly need to do something.

What do you recommend?

Linda

Dr. Pat Responds: 

Dear Linda:

It would be hard for many women to feel lucky if they had two malignancies in their early 40s, along with a surgical menopause.  However, you were lucky that you chose to have a mammogram at 41 and your breast cancer was found early and treated appropriately.  You were lucky that since you were one of the women who developed endometrial cancer from the effect of the tamoxifen on endometrial cells, your gynecologist was monitoring you carefully and an early diagnosis was made and treatment was effective.  But now you find yourself having to deal with the symptoms of a surgical menopause. Many women share your interest in avoiding drugs for symptom management of hot flashes, night sweats and sleep disruption, even without a past history of cancer and concerns about drugs with side effects they might want to avoid.

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An intervention for management of menopausal symptoms based on cognitive behavioral therapy (CBT) has been studied over the last decade and we are now getting information about how this can be used for patients in the real world. CBT is short-term treatment that teaches clients specific skills. This form of therapy focuses on the ways that a person’s thoughts (cognition), emotions, and behaviors are connected and affect one another. In this form of therapy, the therapist helps the client discover that she is capable of choosing positive thoughts and behaviors.  Since this therapy is short-term, the clients actively participate in and out of sessions.  Homework assignments often are included in this therapy, for the skills that are taught in these therapies require practice. Treatment is goal-oriented to resolve present-day problems. Therapy involves working step by step to achieve goals.

Next Page: Studies show the effectiveness of CBT treatment.  Read More »