[00:00:00] Adam Walker: From Susan G. Komen, this is Real Pink, a podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room.
[00:00:17] While menopause is often associated with aging, many women facing breast cancer experience it suddenly and much earlier than expected, bringing a wave of physical and emotional changes. From managing intense symptoms to confronting fears about future family-building, the journey can feel overwhelming.
[00:00:36] On today’s episode, we’re joined by Melody Johnson, a nurse practitioner who specializes in caring for women navigating these exact challenges. She will help us understand how treatment-induced menopause differs from natural menopause, and the strategies available to cope with side effects while already carrying so much.
[00:00:55] We’ll also take a closer look at fertility, an especially emotional and complex issue for younger women diagnosed before they’ve had the chance to start or grow their families. Whether you’re newly diagnosed, supporting someone who is, or simply want to better understand this critical aspect of women’s health, this conversation is here to inform, support, and remind you, you are not alone on this journey.
[00:01:18] Melody, welcome to the show.
[00:01:20] Melody Johnson: Thank you for having me.
[00:01:22] Adam Walker: So Melody, you’re a nurse practitioner. What’s your area of expertise, and what kind of women are you typically working with?
[00:01:29] Melody Johnson: Yeah. So I’m a women’s health nurse practitioner, so I specifically you know, work in that space. Most of my practical experience and background is actually in reproductive endocrinology and infertility, which is basically all things sex hormones at every stage of life.
[00:01:49] It was, you know, kind of while working in the fertility arena that I developed a special interest in what has been coined more more recently as oncofertility which kind of prompted a more recent pivot in my practice to the breast oncology space. And then also, I’ve obviously remained passionate about reproductive endocrinology and fertility preservation.
[00:02:17] Adam Walker: Okay. So that, that sounds very interesting, and like a lot of things that I know nothing about. So so props to you for the good work that you’re doing. So, so menopause has been a hot topic in the news a, a lot lately, but women that you work with a- are often put into menopause early or abruptly during treatment.
[00:02:38] And so prior to that happening, what kinds of things do you educate them on so that they know what to expect?
[00:02:45] Melody Johnson: Yeah, I think that’s one of the most important things about my job and you know, education is key and knowledge is power. So usually I try to frame the approach and expectations as hoping for the best, but expecting the worst when it comes to menopause symptoms.
[00:03:01] So that’s applicable for both medically induced menopause as well as organic, you know, age induced menopause. So I like to explain that everybody’s body has a different relationship and reacts differently to hormones. Some are very sensitive and have a lot more symptoms or side effects, while others have a higher threshold and may not be affected as profoundly to shifts in hormone levels.
[00:03:26] So I feel like it’s important to reiterate that because all you hear about typically is the big, bad, terrible things of menopause, which, don’t get me wrong, are very legitimate but not always the case. And, you know, it’s typically the ones that have, are having the harder time that are very vocal, and the ones that, you know, are kind of having it easier, you don’t really hear much about that.
[00:03:48] So I like to just kind of set that expectation up front because we know that the brain is very powerful and so, you know, expecting this, that you’re going to have this terrible, you know, terrible side effects that you hear about is not always the case. Every person’s going to be different.
[00:04:05] Adam Walker: So you just mentioned that sort of people tend to get what they expect.
[00:04:10] I, I read a really interesting book called The Expectation Effect that actually talked- a lot about that and even talked about there have been medical studies where people knowing that they were on a placebo but led to expect results actually did get some results. I’m just… I have to ask, have you read that book, or have you ever recommended that book to anyone?
[00:04:27] Melody Johnson: Yeah. No, I’ve heard of it. I haven’t read it. But yeah, I think that more and more research is coming out that, you know, the brain is very powerful, and that’s exactly, you know, the placebo effect, right? Like-
[00:04:39] Adam Walker: Yeah.
[00:04:39] Melody Johnson: You know, that’s I think that definitely plays into it and exactly what I try to help my patients, you know, avoid- Yeah
[00:04:47] falling into.
[00:04:48] Adam Walker: Yeah. Yeah. I mean, n- negatively or positively, right? For sure, so.
[00:04:52] Melody Johnson: E- exactly. Yeah. Exactly. Yeah.
[00:04:54] Adam Walker: All right. So so are the side effects a- and symptoms of treatment for induced menopause the same as the age induced menopause, or are there any sort of key differences?
[00:05:05] Melody Johnson: Yeah. So they’re pretty similar for the most part.
[00:05:09] I would say with treatment-induced menopause the side effects are usually more pronounced and abrupt. I hear a lot about joint pain, you know, hot flashes, night sweats, fatigue, weight gain, vaginal dryness, all that, that also comes with you know, age-induced menopause. It’s just kind of… I like to explain it as, you know, treatment-induced menopause is like turning the lights off with a switch, whereas age-induced menopause typically kind of is more of a like a using a dimmer, so not so, you know, abrupt.
[00:05:44] So that’s what I would say is kind of the di- the key difference. That and, you know I hear a lot of times with treatment-induced, I feel like joint pain is almost pretty much number one, whereas I don’t think of that as much with age-induced menopause as being the number one symptom. It’s kind of more the hot flashes, night sweats, but-
[00:06:02] Adam Walker: Gotcha …
[00:06:03] Melody Johnson: any and all can be true. I mean, that analogy of the light switch and the dimmer is actually really helpful sort of to- to frame thinking around that. I appreciate that. I- I’m all about a good analogy, so.
[00:06:14] Yeah. That’s
[00:06:14] Adam Walker: great. Yeah. Now now how are you able to help women cope with menopause related to side effects when they’re already dealing with so many other things?
[00:06:24] Melody Johnson: Yeah. Yeah. That’s a it’s a rough time. I think, you know, even w- without each other, you know, having a kind of a diagnosis with, that many patients have and then dealing with this on top of it kind of compounds the effects. So I would usually kind of say, you know, obviously recognizing that they are…
[00:06:50] this is true, you know, because a lot of times with these kind of more vague symptoms, it’s like, “Is this me? Is this, you know, is this because of the di- you know, a diagnosis? Is this because of, you know, lack of hormones?” and I usually like to say probably yes to all of it, you know, a little bit of everything is probably the most correct answer.
[00:07:09] So I think the, a big part of it is recognizing that, yes, you’re not crazy, and you know, that you’re not alone in, in having these feelings. Unfortunately, with a lot of the cancer, breast cancer patients and especially, you know, hormone positive breast cancer diagnoses, there’s not a lot of, like, medications we can use- or interventions. I mean, the, you know, there are alternatives, and I think that’s kind of a space that’s definitely growing as well. There’s some, you know, name brand medications that are helping with hot flashes that I’ve anecdotally seen, you know, patients do really well with. Yeah. But insurance coverage and cost is always, you know- typically a, can be a inhibiting factor of that- You know, kind of at that stage, whatever, especially when they’re, like, newer medications. Yeah. But I think, again, going back to just kind of recognizing that what they’re feeling is true, and then kind of what can we do, you know, alternatively to help?
[00:08:15] There are- Yeah … there are things out there it’s just w- depending on what you’re experiencing and kind of what your comfort level is with using alternative medications, I think- Yeah … Is a big thing.
[00:08:29] Adam Walker: Yeah, that’s fair. Now now when younger women are diagnosed, I know there’s a lot of stress around fertility, and I understand you’ve got a passion for that.
[00:08:38] So, so what kind of options do young women have when treatment’s looming and they’ve got a desire to have children?
[00:08:46] Melody Johnson: I think that there are many options. You know, I s- I started in the fertility field in 2012, and it was just… Egg freezing was just becoming a thing. And so that’s kind of… Or I should say success- successful egg freezing was becoming a thing.
[00:09:04] Before you could only freeze embryos, so if you were a single woman that wanted to preserve fertility, you didn’t have as many options- because you would either have to choose, you know, a sperm donor to then freeze embryos or, you know, you could… I think they, they were trying to freeze eggs back then, but it wasn’t as a successful of a process- as it has become today. So we’ve come a long way with vitrification of oocyte preservation, and that I feel like has definitely increased women’s reproductive auto- autonomy in general, but especially in the space of fertility preservation for the future.
[00:09:46] So I think it’s really important to, to speak up, that patients speak up for themselves and kind of ask those questions especially if it’s something that they’re considering.
[00:09:56] Because even if you don’t end up using it or your, you know, fertility doesn’t end up being impacted in the long run, you know, it’s kind of like an insurance policy, having the egg, you know, having frozen eggs.
[00:10:08] Adam Walker: Okay. All right, so please forgive an ignorant question here for this next one. But is treatment-induced menopause temporary or is it permanent and are there options for women to, you know, pursue ferti- fertility after treatment?
[00:10:25] Melody Johnson: Yeah, definitely. No, and that’s not a, that’s not an ignorant question at all. And honestly the answer is pretty nuanced. So there are lots of variables depending on, you know, the different type of treatment-induced menopause that you’re in. So, you know, if you were to have, undergo an oophorectomy, so removal of the ovaries, that would be permanent.
[00:10:50] If you’re on medication such as the, like, an aromatase inhibitor- Or a selective estrogen receptor modulator, which is tomo- known as tamoxifen. Those are typically considered reversible, or I sh- I should say not permanent. However, it kind of depends on the age of the patient too. So if you start these medications at 40, while you’re still, you know, not, you know, pre-menopausal-
[00:11:18] Five years from now, if y- once you stop it, that you could technically be in menopause where it just doesn’t … It kind of more jump-starts it, or it doesn’t … You don’t- return to your pre-menopausal state. And so it’s so it’s very age-related as well.
[00:11:35] Adam Walker: Yeah. You, I mean, and it, that does sound like a very nuanced answer, but I mean, I appreciate you sort of walking us through kind of how that all works.
[00:11:42] That’s really helpful. So- so if there i- if there’s someone listening that’s sort of dealing with this, what questions should they be asking their doctor to help them better understand what their options are?
[00:11:53] Melody Johnson: So usually at, you know, an i- with an initial diagnosis of breast cancer you’re not
[00:12:00] The first thought is not necessarily fertility typically, and your oncologist, that’s not their main focus obviously either. So I think it’s important to verbalize that desire upfront. So if you do desire to preserve your fertility or, you know, have build a family in the future, then it’s important to say that upfront because that’s when it’s the best time to get the ball rolling.
[00:12:29] So the first thing that I would say is to go get a an opinion from a reproductive endocrinologist or infertility specialist so that they can get, you know, again, kind of going back to the knowledge is power. You know, you go talk to them, see what your options are, because a lot of times oncologists aren’t the best ones to answer those questions, and that’s not their, that’s not their, you know, obviously their expertise or their primary focus at a time like that.
[00:12:58] So, but again, that’s why it kind of goes back to advocating for yourself, saying that out loud, and then taking that step to just at least go have a consult and talk, see what there, what’s out there and, you know, what the options are.
[00:13:10] Adam Walker: Yeah. Yeah, makes sense. I like that. I appreciate that. That’s good advice.
[00:13:14] That’s good advice.
[00:13:15] All right, so, so why are we talking about this? Why is it important to talk openly about this topic?
[00:13:24] Melody Johnson: I think that’s a great a great thing to ask. So for many years I feel like there’s been a stigma around discussing women’s reproductive health in general, and e- even more so seen as taboo when there’s things that are going wrong- Yeah
[00:13:39] or not perfect, right?
[00:13:41] So I think this is perpetuated kind of a lack of education in the general public, which then allows paths for myths and miseducation to kind of- perpetuate and continue to be spread. So I think openly discussing these topics is, you know, the first step in kind of spreading these, the education and honestly empowering decision-making.
[00:14:10] You know, I think- Yeah … fortunately these topics are being more openly discussed as of, you know, more as of late. And it helps patients not feel so alone.
[00:14:21] You know? And hopefully it encourages them to just, you know gain the courage to speak up and ask for help.
[00:14:29] Adam Walker: Yeah. That’s right.
[00:14:30] That’s right. So important. And that’s, I mean, that’s why we talk about- so many different topics on this show is we-
[00:14:35] Melody Johnson: Yeah …
[00:14:35] Adam Walker: we wanna bring these things to light to help more people as best we can, so.
[00:14:39] Melody Johnson: Yeah. And that’s awesome.
[00:14:40] Adam Walker: What’s your final message for women that have recently been diagnosed but still want to grow their families?
[00:14:48] Melody Johnson: Yeah. It’s a great question. So main thing is there are options. That’s what I kind of wanted to hit home. And, you know, most of these, most of the time, these options will not negatively impact their cancer treatment. And I think that’s the main thing that I would like, you know, to drive home kind of from this, you know, discussion because even oncologists, you know, they…
[00:15:13] Again, they see from their perspective, which again, is priority. We know that. But a lot of times it’s not going to affect their treatment. They’re- yeah … they, you know, many times we start on these you know what they call estrogen blockers initially and, you know, honestly, if you were to go through a egg-freezing cycle we put you on that anyway in an egg-freezing cycle.
[00:15:36] So it’s kind of like you’re, you know, you’re already in that step, so there’s no, there’s not going to be an impact, there shouldn’t be an impact on your treatment.
[00:15:46] Your cancer treatment. You know, again, if you’re waiting to have… You’re on that medication and you’re waiting to have surgery, I mean, it’s typically surgery’s not going to be scheduled within a couple weeks.
[00:15:57] Many of the practices I know in, you know, the DFW where I’m at, and I’m sure any major city really, are going to have providers and resources to be able to get you to go through that, you know, treatment in a timely manner, so kinda speed everything up as opposed to someone who’s just going through it n- not with a cancer diagnosis.
[00:16:20] Adam Walker: Yeah.
[00:16:21] Melody Johnson: And that, you know I think again it’s a, it’s g- It takes time because, again, even egg freezing in and of itself, successful egg freezing is not that old. So even the oncologist, if you think about it, like they don’t even have the same you know, perspective when they were going through and learning about- fertility preservation Right So that’s not top of mind for them many times, which we can all agree is valid.
[00:16:54] While early breast cancer detection and treatment has allowed survival rates to drastically increase, you know, over time, it’s important to also consider survivorship of the upfront diagnosis- Before it’s too late. Yeah. So that and there are options. You know, insurance, because of course cost is always, a, an inhibiting factor, I feel like that people talk about most frequently when it you know, when you talk about reproductive endocrinology and fertility preservation for women.
[00:17:25] But there are programs out there. There are grants available. And so I, I feel like that’s important for patients to know, too, because I- I do think that’s not as widespread. And honestly, more and more insurances are covering it as well. So- Yeah … but even above that, you know, there may be some out-of-pocket costs, of course, and that’s where the grants kind of come into place, too, that you know, are available.
[00:17:51] Adam Walker: Melody, I love the work that you’re doing. It’s important work. Thank you for just caring for this for this group of people that need your help and helping them along the way. You’ve been a great interview and thank you for joining us on the show today.
[00:18:06] Melody Johnson: Yeah. Yeah. Thanks so much, Adam.
[00:18:13] Adam Walker: Thanks for listening to Real Pink, a weekly podcast by Susan G. Komen. For more episodes, visit realpink.komen.org. And for more on breast cancer, visit komen.org. Make sure to check out @SusanGKomen on social media. I’m your host, Adam. You can find me on Twitter @AJWalker or on my blog, adamjwalker.com.