Those of us experiencing menopause after cancer often feel left out of the growing conversation about the lifestage. Research by the brilliant online community, social enterprise and podcast series team Menopause & Cancer, found that 88% of their members did not receive adequate help in managing their menopausal symptoms.
Additional research by the charity Trekstock has found that 48% of oncology or clinical nurses do not discuss menopause [1].
Cancer can cause early or temporary menopause. Our symptoms can be hard to identify alongside symptoms associated with recovery. For many, they are severe. And, because we’re often not told to anticipate them, they can be confusing and distressing too.
‘Doctors will often tell you HRT isn’t an option, depending on the kind of cancer you had, so you’re left on your own, dealing with a double-whammy of menopause symptoms and the trauma, loneliness and anxiety that can follow cancer treatment. Menopause after cancer really is the hidden menopause.’
Dani Binngton, founder of Menopause & Cancer.
‘If you’re under 45 and still having periods, cancer treatment can bring on an early menopause. This leaves you having to cope with the premature loss of your fertility after gruelling cancer treatment, which can be especially painful if you wanted children and haven’t had them. Even if you don’t want children or you’ve completed your family, losing your fertility early can still be very confronting.’
Dani Binngton, founder of Menopause & Cancer.
Research links:
[1] https://www.trekstock.com/news/navigating-menopause-national-lottery-support
‘Women often put up with menopause symptoms after cancer. Lots of us tell ourselves we shouldn’t complain – we’ve survived a life-threatening illness so low libido, hot flashes and insomnia aren’t the end of the world. We’re lucky to be alive – we shouldn’t be moaning. Even if you want to seek help, who do you speak to? It can be difficult to navigate the health system and know whether you should be talking to your oncologist, nurse or GP. And you may well think there’s no point anyway – you can’t have HRT and nothing can be done so you’ll just have to put up with it.’
Dani Binngton, founder of Menopause & Cancer.
Research shows that 73% of cancer survivors are thought to be using complementary medicine to manage symptoms. But scaled research into both risks and potential is limited. This is even more true of studies that specifically address dietary supplements, including botanicals, and menopause following cancer.
There is also confusion around the difference between the potential of botanicals in their wholefood form and as extracts - and at what point in an individual’s recovery ingredients may pose a risk.
We know how frustrating this can be.
‘I feel let down. I cannot use medical routes and supplements are a grey area.’
LIMINAL Community Research, 2022’
The answer, we believe, is to share what we do know, to highlight what remains unclear…and to share the sources to find out more, so that each of us is able to make a personal decision. Download our Support Booklet below, or read on for a summary of the most common questions asked by our community.
Safety notice: All content produced by LIMINAL is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The content produced by LIMINAL is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not disregard or delay in obtaining medical advice for any medical condition you may have and should seek the assistance of your health care professionals for any such conditions. Before introducing any interventions explored or offered by LIMINAL, you should always consult with your medical practitioner.
The most commonly asked questions about menopause, botanicals and cancer.
1. What are phytoestrogens? And should they be avoided in our diets after oestrogen receptor-positive cancer?
Phytoestrogens are a group of substances naturally found in plants that are structurally similar to the oestrogen molecule that is made in our bodies. There are 2 major classes of phytoestrogens: isoflavones and lignans. Other classes are coumestans and stilbenes, but are less abundant in the diet and less well-studied.
The most common form of phytoestrogens are called isoflavones, with the greatest dietary source being soya. Other legumes such as chickpeas and green peas also contain isoflavones but in significantly lower levels. It’s useful to know that several factors can actually affect isoflavone content, such as the location of a crop, the time of harvest, processing, and preparation. For example, boiling soya beans can decrease isoflavone content by more than half.
The second most abundant class of phytoestrogen, lignans, is mainly present in flaxseed, although whole grains, vegetables, and tea are also sources.
Because phytoestrogens have oestrogenic effects in the body, they can be very useful in supporting menopausal symptoms when our natural levels of oestrogen start to decline. There is plenty of research showing their health benefits, from reducing hot flushes to improving bone health.
And concerns about phytoestrogens primarily relate to these oestrogenic effects and how they may affect hormone-sensitive types of cancer, including breast cancer. Although research to date is not conclusive, epidemiologic studies show that people who have been consuming phytoestrogens through their daily diet since childhood have a decreased risk of developing breast cancer, while the studies examining the effects of adult exposure and risk of breast cancer are quite heterogeneous.
Still, experts believe that there is no reason to avoid phytoestrogens in the form of food after breast cancer, if taken in moderate amounts and as part of a balanced diet low in saturated fats and high in fruits and vegetables. However, the intake of phytoestrogens in the form of a supplement is not recommended after breast cancer. Please also note that most research to date on phytoestrogens and safety after breast cancer has been conducted on soya. For more information, please read on below.
Research links:
https://pubmed.ncbi.nlm.nih.gov/17855484/
https://pubmed.ncbi.nlm.nih.gov/36551648/
https://www.bcpp.org/resource/phytoestrogens/
2. Is it safe for me to have soya in my diet following cancer? And what is the difference between soya products and soya extracts or isoflavones?
The relationship between soya consumption and breast cancer has been a subject of considerable research, and findings have evolved over time.
Soya is rich in isoflavones, and early concerns about soya consumption are linked to its oestrogenic effects and how it might impact hormone-sensitive breast cancer. More recent research has provided mixed findings, with some studies suggesting that moderate soya consumption may be associated with a reduced risk of oestrogen receptor-positive breast cancer recurrence and improved survival rates, while other studies have not found significant effects. Moreover, more recent research suggests that soya isoflavones may act differently in the body than oestrogen.
Population studies in Asian countries, where soya consumption is traditionally high, have shown lower breast cancer rates. This has led to hypotheses that the protective effects of soya may be closely linked to its dietary consumption throughout life.
How about soya and hormone receptor-negative breast cancer?
The relationship between soya consumption and hormone receptor-negative breast cancer is less clear and has been less extensively studied. However, some studies suggest that soya may not have the same protective effects in hormone receptor-negative breast cancer as observed in hormone receptor-positive cases.
How about soya and HER2-positive breast cancer?
The relationship between soya and HER2-positive breast cancer is not as well-studied as the relationship with hormone receptor-positive breast cancer. In one study of Korean women, dietary soya intake was associated with a decreased rate of recurrence in HER-2 negative cancer, but an increased rate of recurrence in women whose tumours were HER-2 positive. However, the evidence is limited and not consistent to date, and more research is needed to draw conclusions.
In summary, research shows that eating whole soya foods is unlikely to increase your risk of getting breast cancer, and if you had breast cancer, eating soya foods is unlikely to increase your risk for recurrence.
Experts emphasise that if individuals choose to include soya in their diet after breast cancer, it should be in moderation and in the form of whole foods as opposed to concentrated and highly processed forms such as in the form of a supplement. Wholefood forms of soya include tofu, edamame, and soya milk, which provide a range of nutrients and fibre that have additional health benefits. It is believed that fermented whole food forms of soya – such as Tempeh, Natto and Miso - are even better, as fermentation increases bioavailability and provides probiotic properties. Remember to opt for organic non-GMO soy.
Please also note that individual responses to soya and phytoestrogens in general can vary, and factors such as age, type of breast cancer, hormonal receptor status, diet, gut microbiota profile, and overall health should be considered. Some women may tolerate soya well, while others may choose to limit their intake.
Research links:
https://pubmed.ncbi.nlm.nih.gov/19403632/
https://pubmed.ncbi.nlm.nih.gov/24312387/
3. Is it safe to add flaxseeds to my diet after breast cancer?
Flaxseed, also known as linseed, is the richest source of the second most abundant class of phytoestrogens, called lignans.
A clinical trial has shown that 25 g per day of dietary flaxseed has the potential to reduce tumour growth in postmenopausal breast cancer patients. However, the research on flaxseed in breast cancer is still limited. The general recommendation seems to be that moderate amounts of ground flaxseeds (up to two tablespoons per day at most) through diet, in the form of wholefoods, are considered safe.
Flaxseed is also a rich source of Omega-3 in the form of alpha-linolenic acid (ALA) and fibre, providing additional health benefits in regards to cardiovascular and gut health.
Research links:
https://pubmed.ncbi.nlm.nih.gov/15897583/
https://pubmed.ncbi.nlm.nih.gov/29468163/
https://www.oncologynutrition.org/erfc/healthy-nutrition-now/foods/flaxseeds-and-breast-cancer
4. Is it safe for me to use turmeric in my cooking following breast cancer?
Turmeric's main active component - curcumin - has been shown to have several properties including anti-inflammatory, metabolic-regulating, immune-modulating, mood-enhancing and even anti-cancer benefits.
Using turmeric as a spice in cooking is generally considered safe after breast cancer, when incorporated into a balanced diet. Cooking with turmeric adds flavour to dishes without necessarily providing high concentrations of curcumin.
Remember that curcumin is usually poorly absorbed, and that addition of black pepper and fat to a dish, increases its bioavailability.
In regards to safety of turmeric in the form of a supplement, which typically contains higher concentrations of curcumin than those found in food, concerns are mainly linked to breast cancer patients who are undergoing treatment, particularly chemotherapy and tamoxifen. For instance, research has shown that taking curcumin alongside tamoxifen could reduce drug concentration below the threshold for efficacy, in potentially 20–40% of patients. It should be acknowledged however that this study used very high concentrations of curcumin, and significantly higher than those seen in supplements. In regards to turmeric and chemotherapy drugs, the data so far is inconclusive. Some studies show a potential negative interaction while others actually suggest that curcumin can increase effectiveness of chemotherapy by reducing toxic effects. Nonetheless, the current evidence has been mainly obtained from breast cancer preclinical models, therefore the clinical significance is not yet known. At this stage, if undergoing cancer treatment for breast cancer it is advisable to check with your healthcare provider before taking turmeric in the form of a supplement.
In summary:
Research shows that eating whole soya foods is unlikely to increase your risk of getting breast cancer, and if you had breast cancer, eating soya foods is unlikely to increase your risk for recurrence.
Research links:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468355/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8878285/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8878285/
5. What common botanicals in menopause supplements contain phytoestrogens and should I avoid them following cancer?
Botanicals commonly used to relieve menopausal symptoms that have significant levels of phytoestrogens include soya, red clover, sage, hops, and black cohosh. Experts generally recommend that women with a history of oestrogen receptor-positive breast cancer should avoid supplements containing phytoestrogens, particularly in highly concentrated forms.
However, research does support the safety, and even a potential protective effect, of phytoestrogens in the form of wholefoods.
A whole body and mind approach to menopause.
Regardless of our journey into menopause, we believe that the best route through is to address the whole body and mind. From mindset to nutrition, from rethinking how we secure sleep to rethinking how we move, we may find we need to add new elements to our toolkit to feel well.
The role of naturopathy in your menopause journey.
Naturopathy has a truly holistic view of health, offering a 360 view to nourish and balance our bodies and minds. It relies on science-backed tools such as nutrition, botanicals/herbal medicine, and lifestyle modifications, which can (and should) be implemented alongside conventional medicine. It may also explore additional evidence-based complementary practices such as CBT, EFT, yoga and acupuncture.
When considering supplementation, it is critical that you speak to your health provider and do your own reading. The frustrating reality is that research remains early in many areas. However, theses are the steps we recommend you take to work out what may be right for you:
Check potential interactions: some supplements may interact with medications used in breast cancer treatment. Make sure you check against your prescriptions and treatment plan.
Hormonal effects: although research is evolving all the time, supplements containing phytoestrogens may have oestrogenic effects in the body that could be of concern for individuals with hormone-sensitive breast cancer.
Quality and safety: choosing reputable brands and discussing supplements with your healthcare provider first can help ensure that you are using high-quality and safe products.
Individual variability: everyone is different and responses to supplements can vary too. What may be safe for one person may not be safe for you. Health conditions, allergies, and individual tolerances should always be considered. Our blends pack a powerful punch. Which means it is critical to speak to your specialist before introducing any of our blends into your daily routine. To help the conversation, below is a summary of the existing research into the key components in our blends. Please note each product summary is designed to aid evaluation only and not designed to act as medical advice.
PERI-BOOST contains soya isoflavones in the form of an extract, at approximately 37mg per daily serving. Although this represents a moderate daily amount of isoflavones and is consistent with that of a traditional Japanese diet of 25 - 50mg daily isoflavones, experts recommend that if individuals choose to safely include soya in their diet after breast cancer, it should be in the form of wholefoods as opposed to processed forms such as extracts.
Flaxseed, which is a source of another class of phytoestrogens called lignans is present in this formulation too. A daily scoop provides approximately 1.7g of flaxseed in the form of wholefood per daily serving. And although the research on flaxseed in breast cancer is limited when compared to soya, a clinical trial has shown that 25g per day of dietary flaxseed has the potential to reduce tumour growth in postmenopausal breast cancer patients. The general recommendation seems to be that moderate amounts of ground flaxseeds (up to two tablespoons per day at most - which significantly more than the amount present in Peri-Boost) through diet in the form of wholefoods is considered safe.
PERI-BOOST also contains ginger, which means that if you have a bleeding disorder or are taking blood-thinning medication (e.g. aspirin) you should talk to your doctor first.
MENO-BOOST contains red clover in the form of an extract with a content of isoflavones at approximately 6.4 mg per daily serving. This is a significantly lower amount of isoflavones compared to the typical 25-50 mg daily intake in a traditional Japanese diet. In addition, a 3-year randomised double-blind controlled pilot trial with 401 women with a family history of breast cancer, demonstrated that 40 mg of red clover daily in the form of a supplement appears to be safe and well tolerated. Compared with the placebo group, there was not an increased risk of breast cancer, endometrial thickness, or hormonal changes.
However, because the research on red clover’s safety in breast cancer is still limited and due to its content of isoflavones, experts recommend that women with a history of oestrogen receptor-positive breast cancer should avoid red clover as a supplement.
MENO-BOOST also contains maca, a herb with adaptogenic properties. Although maca doesn’t seem to contain phytoestrogens, some studies have shown its potential to alter sex hormone levels, possibly through the Hypothalamus-Pituitary-Ovarian axis. Therefore, caution should be taken, particularly in women with a history of oestrogen receptor-positive breast cancer.
There are no known contraindications with the ingredients present in MOOD-FOOD and breast cancer. However, if you are undergoing treatment for breast cancer that includes tamoxifen or chemotherapy, MOOD-FOOD may be contraindicated due to the presence of turmeric extract.
There is some clinical research showing that curcumin, the active ingredient in turmeric, can reduce tamoxifen concentration, although this study used a concentration of curcumin significantly higher than those seen in supplements. In regards to turmeric and chemotherapy drugs, the data so far is inconclusive as some studies show a potential negative interaction while others actually suggest that curcumin can increase effectiveness of chemotherapy by reducing toxic effects. It should also be noted that the current evidence has been largely obtained from breast cancer preclinical models, therefore the clinical significance is not yet known.
Although the data so far is not conclusive, if undergoing treatment for breast cancer it is advisable to check with your healthcare provider before taking turmeric in the form of a supplement.
There are no known contraindications in regards to the ingredients present in GUT-INSTINCT and breast cancer, including for those still undergoing treatment for breast cancer.
We advise a 2 hour break between taking any oral cancer medication and Gut-Instinct capsules. This is because Gut-Instinct contains marshmallow root, a mucilaginous herb. Although the amount of marshmallow root is low, mucilaginous herbs have a “coating” effect on the digestive tract and can potentially make medications harder to absorb.
GUT-INSTINCT also contains ginger. If you have a bleeding disorder or are on blood thinning medication (e.g. aspirin) please seek medical advice. This formulation should also not be used if you have bile duct obstruction, gallstones, or severe liver or kidney disease, due to the presence of artichoke leaf extract.
Our LIMINAL Masterclasses are designed to feed your curiosity. Each month our founder, Rebekah Brown, invites a leading expert in their field to share their knowledge, practical actionable tips as well as their own lived experience of menopause, so you can work out what may work for you. To see what is coming up, click below.
We sat down with Menopause & Cancer founder Dani Binnington, to discuss how her own cancer and menopause journey led to the founding of a charity, a community and the world’s first podcast dedicated to the topic.
LEARN MORE:
LIMINAL Menopause & Cancer booklet
Memorial Sloan Kettering Cancer Centre
Safety notice: All content produced by LIMINAL is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The content produced by LIMINAL is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should not disregard or delay in obtaining medical advice for any medical condition you may have and should seek the assistance of your health care professionals for any such conditions. Before introducing any interventions explored or offered by LIMINAL, you should always consult with your medical practitioner.
