After pulling through breast cancer, a patient faces new problems

Monica, 48, is a married woman with a five-year-old child.

She has a history of oestrogen receptor-positive, left breast cancer which was treated with mastectomy at the age of 46.

She presents with amenorrhoea and menopausal symptoms which have become particularly troublesome since starting tamoxifen.

A non-smoker of healthy weight, Monica has severe, frequent hot flushes, insomnia, dry vagina, low libido, anxiety, irritability and labile moods. She has trialled prescription drugs but didn’t tolerate many. She is