Navigating Surgical Menopause and Triple Negative Breast Cancer (TNBC)

December 23, 2024

When I received the results of my genetic testing, confirming that I carried the PMS2 and BRCA2 gene mutations, my life was forever altered. In that moment, I realized this wasn’t just about me—this was about breaking generational cycles of cancer and taking control of my future. As a Black woman, I also understood that health disparities and systemic barriers in my community often meant lives were lost unnecessarily. I couldn’t let that be my story.

This knowledge empowered me, but it also forced me to confront difficult truths and make decisions I never imagined. Among those decisions was to undergo a complete hysterectomy—a choice that would reduce my cancer risk but would also thrust me into surgical menopause and challenge every part of my emotional and physical existence. It wasn’t easy, but it was necessary. And it was just the beginning of my journey.

From Knowledge to Action

The moment I learned of my genetic mutations, I knew the stakes were high. The numbers weren’t in my favor—an increased risk of ovarian, breast, and other cancers loomed over me. I wasn’t just looking at the statistics, though; I was looking at the faces of my family. My daughters carried some of the same genetic mutations, and I needed to set an example.

After months of consultations with specialists, I made one of the most significant decisions of my life: to have a complete hysterectomy. On the surface, it seemed like a straightforward medical procedure, but the emotional reality was far more complicated. This wasn’t just surgery—it was a leap into the unknown.

What is Surgical Menopause?

Surgical menopause occurs when the ovaries are removed, causing an immediate and dramatic drop in hormones like estrogen and progesterone. Unlike natural menopause, which happens gradually, surgical menopause is abrupt. It’s like flipping a switch, and the impact can feel overwhelming.

For me, this meant intense hot flashes, mood swings, fatigue, and changes to my libido. My body suddenly felt unfamiliar, and the emotional weight of those changes was heavier than I expected. My gynecologist and I tried different doses of estrogen to help alleviate symptoms, but the pills didn’t bring the relief we hoped for. This added yet another layer of frustration and fatigue to my already complicated journey.

Understanding Estrogen: Types, Levels, and Risks

Estrogen is one of the most important hormones in the female body, playing a key role in regulating the menstrual cycle, maintaining bone health, and supporting heart and brain function. When the ovaries are removed during a hysterectomy, the body loses its primary source of estrogen, leading to the symptoms of surgical menopause.

Types of Estrogen

There are three primary types of estrogen found in the body:

Estradiol (E2): The most common type of estrogen in premenopausal women. It is produced by the ovaries and regulates reproductive functions. Estradiol is often prescribed as part of hormone replacement therapy (HRT) to manage menopausal symptoms.
Estrone (E1): The primary estrogen in postmenopausal women. It is produced in small amounts by fat tissue and the adrenal glands. Estrone is weaker than estradiol but still plays a role in regulating bodily functions after menopause.
Estriol (E3): Produced during pregnancy and in very small amounts outside of pregnancy. It is not typically used in HRT.

What Do Estrogen Levels Mean?

Low Estrogen Levels: Low levels of estrogen can lead to symptoms such as hot flashes, vaginal dryness, mood swings, and decreased bone density. For women in surgical menopause, these symptoms can be more severe due to the abrupt loss of ovarian function.
Optimal Estrogen Levels: Maintaining balanced estrogen levels through HRT or other therapies can help alleviate menopausal symptoms, improve bone health, and reduce the risk of heart disease.
High Estrogen Levels: Excess estrogen can increase the risk of blood clots, stroke, and certain cancers, particularly in women with a history of hormone-sensitive cancers.

Risks of Taking Estrogen

While estrogen can provide significant relief from menopausal symptoms, it is not without risks. For women with a history of breast cancer, like me, the decision to use estrogen therapy is complex and requires careful consideration.

Some risks associated with estrogen therapy include:

Increased Risk of Breast and Uterine Cancer: Estrogen-alone therapy (without progesterone) can increase the risk of endometrial cancer in women with a uterus. For women with a history of breast cancer, the use of estrogen must be closely monitored.
Blood Clots and Stroke: Estrogen therapy can increase the risk of blood clots and stroke, particularly in women with pre-existing risk factors such as smoking, obesity, or a history of cardiovascular disease.
Gallbladder Disease: Hormone therapy can increase the risk of gallstones and other gallbladder issues.

Alternatives to Estrogen Therapy

For women unable to take estrogen due to cancer risks, there are non-hormonal treatments available to manage menopausal symptoms:

Selective Serotonin Reuptake Inhibitors (SSRIs): Often prescribed to help with hot flashes and mood swings.
Vaginal Moisturizers and Lubricants: To address vaginal dryness and discomfort during intimacy.
Diet and Lifestyle Changes: Incorporating a balanced diet, regular exercise, and stress management techniques can help alleviate symptoms naturally.

Discussing these options with a healthcare provider is essential to finding a safe and effective solution.

Navigating Breast Cancer and Surgical Menopause’s Impact on Relationships

Surgical menopause didn’t just affect me—it rippled through every part of my life, including my relationships. My husband, Russell, was my rock, but even he struggled to navigate the changes we were facing together. The mood swings, physical discomfort, and decreased intimacy created distance between us at times.

Breast cancer only deepened the complexity. The surgeries, chemotherapy, and changes to my body left me feeling vulnerable and, at times, unworthy of love. Intimacy became a sensitive topic, not just physically but emotionally. I withdrew in moments when I felt like a burden, but Russell refused to let me push him away. His patience and unwavering support taught me that love evolves through challenges, and honesty is essential in weathering those storms together.

How Menopause Impacts Partners

Menopause doesn’t just affect the individual experiencing it—it also impacts their partners. For many partners, the physical and emotional changes can feel unfamiliar and challenging to navigate. Without proper communication and understanding, menopause can strain relationships in significant ways.

Partners may experience:

Confusion: Uncertainty about how to respond to mood swings or physical symptoms.
Frustration: Feeling powerless to help or unsure of what their partner needs.
Emotional Distance: Difficulty maintaining connection due to changes in intimacy or communication patterns.

It’s important to recognize that these reactions are natural and not uncommon. Educating partners about menopause can provide the understanding needed to support their loved ones through this transition. It also helps partners feel more empowered and connected rather than helpless or excluded.

Menopause and Intimacy

One of the most challenging aspects of menopause—especially surgical menopause—is its impact on intimacy. Hormonal changes can affect physical and emotional connection in relationships, making it harder to maintain closeness with a partner.

Physical Changes

Vaginal Dryness and Discomfort: The drop in estrogen levels can lead to thinning of vaginal tissues, decreased lubrication, and pain during intimacy. These physical changes can make sexual activity uncomfortable or even painful, creating barriers to intimacy.
Decreased Libido: Many women in menopause experience a reduced interest in sexual activity. This can be tied to hormonal changes, fatigue, stress, or emotional factors like body image concerns.

Emotional Challenges

Body Image: Menopause, coupled with the physical changes from breast cancer surgeries, can leave women feeling self-conscious about their bodies. Scars, weight changes, and a loss of connection with one’s pre-menopausal body can affect confidence.
Emotional Disconnect: The stress and fatigue of dealing with menopausal symptoms or cancer recovery can lead to emotional withdrawal, making it difficult to engage in intimacy, even in non-sexual ways.

Rebuilding Intimacy

While the changes menopause brings can feel overwhelming, they are not insurmountable. Here are steps to help rebuild intimacy:

Open Communication: Talk openly with your partner about how you’re feeling. Share your fears, frustrations, and needs. This fosters understanding and prevents feelings of rejection on both sides.
Explore Non-Sexual Intimacy: Physical closeness doesn’t always have to be sexual. Holding hands, cuddling, or sharing quality time together can help rebuild emotional bonds.
Seek Medical Solutions: Vaginal dryness can be treated with lubricants, vaginal moisturizers, or low-dose estrogen creams (if approved by your doctor). Non-hormonal options are also available for those with a history of hormone-sensitive cancers.
Therapy and Counseling: Couples therapy or individual counseling can provide tools to navigate intimacy challenges. A licensed sex therapist can also help explore ways to reignite passion and connection.

Strategies and Resources for Navigating Challenges

Navigating menopause and its impact on relationships requires empathy, education, and communication. Here are strategies and resources for both individuals and their partners:

For Individuals Experiencing Menopause

Open Communication: Share your feelings and needs openly with your partner.
Seek Medical Support: Work with a gynecologist to explore treatment options like hormone replacement therapy (HRT) or non-hormonal alternatives.
Join Support Groups: Connect with others navigating similar challenges.

For Partners

Educate Yourself: Learn about menopause to understand what your partner is experiencing. Resource: North American Menopause Society (NAMS)
Practice Patience and Empathy: Acknowledge your partner’s challenges without judgment.
Seek Counseling: Couples therapy can provide tools for navigating relationship changes. Resource: American Association for Marriage and Family Therapy (AAMFT)

Local and National Resources

1. The Ohio State University Comprehensive Cancer Center

Address: 460 W. 10th Ave., Columbus, OH 43210
Phone: 800-293-5066
Email: jamesline@osumc.edu
Website: cancer.osu.edu

2. OhioHealth Women’s Health Programs

Address: 3430 OhioHealth Parkway, Columbus, OH 43202
Phone: 614-566-1111
Website: ohiohealth.com

3. Susan G. Komen Central & SE Ohio

Contact Person: Lindsay Grubaugh, Executive Director
Email: lgrubaugh@komen.org
Phone: 1-877-GO KOMEN
Website: komen.org

4. American Cancer Society (ACS)

Address: 270 Peachtree St NW, Suite 1300, Atlanta, GA 30303
Phone: 1-800-227-2345
Website: cancer.org

5. Prowl the Lab

Address: 2035 South State Street #16379 Chicago, IL. 60616
Phone: 312-566-8236
Email: info@prowlthelab.com
Website: prowlthelab.com
Services: Offers resources on mental wellness, women’s empowerment, and navigating transitions like menopause and health challenges. Ideal for individuals seeking personal growth, confidence-building tools, and a supportive community.

A Call to Action

Menopause, breast cancer, and surgical changes aren’t just medical journeys—they’re emotional, relational, and deeply personal experiences. My journey is far from over. I’m learning, growing, and advocating—not just for myself but for my daughters, my family, and others who need a voice. In this journey, no one walks alone. Together, we can break the silence, support one another, and thrive through life’s transitions.

By sharing my story, I hope to shed light on the complexities of this process and provide hope to those navigating similar challenges.