Facing menopause after cancer

Battling cancer is a traumatic experience in its own right. Treatment can leave you feeling fatigued and sick, but did you know that some cancer treatments can also bring on menopause? Along with the challenges of coping with cancer, women may suddenly experience physical symptoms of menopause such as hot flushes and vaginal dryness, as well as confronting the loss of their fertility. For women who are already going through menopause when they are diagnosed with cancer, this may mean they have to reassess their menopause treatment options.

Surgical and medically induced menopause

Chemotherapy drugs are toxic to the ovaries, affecting ovarian function. The risk of a woman going through menopause because of chemotherapy varies according to her age, treatment dose and type, and duration of treatment.

The older a woman is, the stronger the dose of chemotherapy and longer the duration of treatment, the greater the menopause risk. Up to 80% of women who have chemotherapy experience premature menopause.

“After a couple of cycles of chemotherapy, women may develop symptoms such as hot flushes, vaginal dryness, sleep disturbance and sexual dysfunction. This may occur quickly or over time,” says Dr Amanda Vincent, endocrinologist and Research Fellow at Jean Hailes Foundation Research Unit, Monash University.

Surgical removal of the ovaries to treat cancer always causes menopause and symptoms often come on suddenly. Female hormone levels – oestrogen and progesterone – drop within 24 to 48 hours of surgery. Young women who lose their ovaries also lose their main source of testosterone. Testosterone is believed to play a role in sexual desire and response. Up to 90% of women with cancer experience sexual dysfunction, which can be related to many different things, including hormonal changes.

Other symptoms of menopause after cancer treatment include: night sweats, fatigue, crawling or itching skin sensation, memory and concentration difficulties, hair and skin changes, aches and pains, palpitations, and psychological symptoms such as irritability, depression and mood changes.

Young women and children

“Younger women usually experience more severe symptoms and greater psychological distress, because they face the added issue of infertility and feeling ‘out of step with their peers’ or ‘old before their time’”, says Amanda. Body image issues can also be more significant in younger women.

Childhood cancer sufferers who have chemotherapy treatment are at increased risk of premature menopause.

Premature menopause also brings an increased risk of osteoporosis and cardiovascular disease. Oestrogen is important for bone density and menopause reduces oestrogen levels. Some cancer treatments also cause bone loss, adding to the osteoporosis risk.

Cardiovascular disease risk increases after premature menopause because the long-term drop in oestrogen levels may increase a young woman’s chance of developing hardening of the arteries, which can lead to heart attack or stroke.

Women already going through menopause

Some women will already be going through menopause when diagnosed with cancer. The average age of menopause in Australia is around 51 years and breast cancer is more common in women after the age of 50.

Women who have gone into menopause naturally may be using hormone replacement therapy (HRT) to relieve menopausal symptoms. A cancer diagnosis can force a change in treatment for these symptoms as some types of cancer are incompatible with HRT.

These women face the shock of a cancer diagnosis and then have to deal with of the return of uncomfortable and distressing menopausal symptoms. “Postmenopausal women with cancer also need to take steps to avoid osteoporosis, by ensuring adequate calcium intake and good vitamin D levels, doing regular weight-bearing exercise, and by having more specific treatments if they are diagnosed with low bone density,” says Amanda.

Women with oestrogen dependent cancers

Oestrogen dependent cancers include endometrial and breast cancer. Women with oestrogen-receptor positive breast cancer are commonly prescribed adjuvant medication, such as Tamoxifen and Aromatase Inhibitors. These treatments can cause menopausal symptoms including hot flushes, vaginal dryness, sexual dysfunction and bone density loss leading to fractures.

“Women with oestrogen dependent cancers should generally not use HRT and unfortunately the other therapies available to treat this group are not as effective at relieving hot flushes and vaginal dryness,” Amanda explains. “However, nonoestrogen therapies provide some relief of symptoms in 60 to 70% of cases. Often women don’t need their symptoms to disappear completely,” says Amanda. “If their sleep or daytime functioning can be improved, that may be enough.” Non-oestrogen vaginal moisturisers and lubricants can help with sexual intercourse and women can also improve symptoms themselves with some simple lifestyle changes such as dressing in layers, avoiding spicy foods and excess alcohol.

Women diagnosed with non-oestrogen dependent cancers (e.g. bowel cancer) can continue to use HRT to relieve their menopause symptoms.

Complementary Therapies

Women often turn to complementary therapies to manage menopause symptoms. Amanda recommends caution, as the effectiveness and safety of complementary therapies for alleviating menopausal symptoms is not currently proven. The evidence is conflicting and many studies are of poor quality.

“We have limited information regarding the safety of these therapies in women with breast cancer, and concerns about interaction with conventional cancer treatments.”

“Some herb and plant medications can have side effects and interact with medication. It’s important that women who are taking non-prescription therapies tell their health practitioner.”

In managing menopause after cancer, Amanda recommends assessing the likely causes for menopausal symptoms, identifying the type/ frequency/severity of symptoms and the impact on quality of life, and then discussing the wishes and expectations of the woman being treated.

Obtaining information and psychological support can also help women better manage menopause after cancer.

Useful Resources

www.jeanhailes.org.au

The Foundation is studying emotional wellbeing and attitudes about health in women aged between 40 and 55 years with breast cancer who have undergone menopause and in young women aged 21-40 who have developed premature menopause due to surgery or chemotherapy.

We are looking at issues such as mood, body image, sexual function, diagnosis, treatments and feelings about those treatments, health concerns and attitudes and beliefs about health. Look at the Research section of the website for more information.

www.menopause.org.au

www.nbocc.org.au

If you have been recently diagnosed with breast cancer and would like to order the free comprehensive information resource My Journey Kit please call 1300 78 55 62 or visit www.bcna.org.au

Clinics specifically for women with menopause and cancer

The Menopause After Cancer Clinic
Menopause unit
Monash Medical Centre
Southern Health Clayton, Victoria

Menopausal Symptoms After Cancer Clinic
King Edward Memorial Hospital
Perth, Western Australia

Content Updated November 23, 2009