Induced Menopause and Cancer
DOES INDUCED MENOPAUSE HAVE THE SAME SYMPTOMS? HOW DO I MANAGE VMS? IS HRT SAFE IF I HAVE BREAST CANCER? FIND THE ANSWERS TO YOUR QUESTIONS HERE.
Written by: Perci Team
Medically approved by: Professor Peter Schmid
Last updated: September 13, 2021
Menopause affects every woman at some point. Yet isn’t spoken about or discussed nearly enough.
Throw into the mix, induced menopause due to cancer treatment or surgery and the sense of isolation and fear can be even greater. However, there are many options and adaptations that can be made to help ease the symptoms associated with menopause.
Here, Johanna Bowie, Perci’s gynaecological cancer nurse and menopause specialist, and Beverley Longhurst, a Perci hypnotherapist with extensive menopause symptom related management experience as a CNS, offer reassurance and answers to the most commonly asked questions.
IN WHAT INSTANCES DOES MENOPAUSE OCCUR IN A PERSON WHO HAS CANCER?
Menopause can be induced by various oncology treatments and surgeries. Sometimes the menopause symptoms are temporary and it may be that a women’s ovarian function returns following a course of treatment. In other scenarios, the menopause will be permanent.
Essentially, any anti-cancer treatment that damages the ovarian function, will lead to a drop in oestrogen production and menopausal symptoms. It’s important to acknowledge that men can also experience hormone-related side-effects from breast cancer treatments and also some prostate cancer treatments. Due to this article being specific to the induced menopause women experience, we’d encourage men to seek support for any hormonal changes and side effects they’re experiencing, and check back for a follow-up article on the hormonal consequences of cancer, on men.
WHICH ONCOLOGY TREATMENTS CAN INDUCE MENOPAUSE?
Pelvic radiotherapy and surgery involving removal of the ovaries, are two treatments that always result in a permanent menopause. A radical hysterectomy is an operation that is often performed when a woman is diagnosed with a gynaecological cancer. This involves removing both ovaries, the fallopian tubes and the uterus. It is possible for menopausal symptoms to start as soon as the woman wakes from her anaesthetic. This is because oestrogen is produced in the ovaries, therefore removal or damage to these organs leads inevitably to the menopause.
Chemotherapy will often damage the ovaries, resulting in the menopause. It is possible for the damaged ovaries to repair once chemotherapy is complete, but this is not always the case and often a woman’s ovarian function will resume, but may not be as efficient as it was pre-treatment. Periods may be irregular, fertility may be affected and women may experience some menopausal symptoms despite their periods resuming. The closer a woman is to the time of her natural menopause, the more likely her ovarian function will not resume post chemotherapy.
Bone marrow and stem cell transplants will always lead to a premature menopause, even in young women and adolescents. This is usually the result of high dose chemotherapy and or total body irradiation.
Menopause affects every woman at some stage of their life
Hormone or anti oestrogen treatments, which are commonly used to treat and prevent patients with oestrogen receptive breast cancers and some gynaecological cancers, can cause menopausal symptoms, although they will not make the woman menopausal. When these treatments have stopped, ovarian function will sometimes resume. This depends on a number of factors, including the type of chemotherapy given and the woman’s age when she completes the course of treatment. These drugs include aromatase inhibitors, estrogen receptor down-regulators and selective estrogen receptor response modulators (such as Tamoxifen, Letrozole and Arimidex).
ARE THE SYMPTOMS OF INDUCED MENOPAUSE THE SAME AS THOSE IN NATURAL MENOPAUSE?
Whether the menopause has been induced by oncology treatment, or you are of the natural menopause age, symptoms are similar and can feel challenging to manage.
Diagnosis of the menopause is based on symptoms and it is not usually necessary to have blood tests to determine whether a woman has entered the peri-menopausal phase of life.
According to the British Menopause Society (2021) the most common symptoms experienced include:
Vasomotor symptoms (VMS), including hot flushes and night sweats which are the most common symptoms of the menopause
Irregular periods, or cessation of periods
Dry hair &/or dry skin
Arthralgia (aching joints)
Headaches
Psychological symptoms such as low mood, anxiety, mood swings & irritability
Insomnia
Vaginal dryness, painful intercourse, low libido
Urinary frequency & urgency
Whilst most women are unlikely to experience all of the above symptoms simultaneously, many will find that they tick most of the boxes some of the time, while others may only experience a couple of these symptoms. Current research indicates that up to 70% of women in Western society will experience vasomotor symptoms (British Menopause Society (BMS), 2021).
WHAT IS HRT AND IS IT ADVISABLE TO HAVE IT IF I HAVE OR HAVE HAD CANCER?
Hormone replacement therapy (HRT) is an extremely effective way of managing the symptoms of menopause, however there are other options for those women (particularly breast cancer patients and some gynaecological cancer patients) for whom HRT is deemed high risk.
It is also important to understand that HRT should not be ruled out completely, but it is important to weigh up the risks vs. the benefits with your primary cancer team.
The fact that it is not advised for many cancer patients to take hormone replacement therapy (HRT) adds a layer of complexity when managing menopause.
Women with endometrial and oestrogen receptive breast cancers are usually advised by their oncologists to avoid any form of oestrogen replacement. If their symptoms are severe, it is likely that their oncologist will send them to a specialist menopause clinic or consultant, to discuss their symptoms and ways of managing their menopausal symptoms. These specialist clinics are available both on the NHS and privately.
HRT is usually safe to consider in women that do not have an estrogen receptive breast cancer, as well as those with ovarian and cervical cancer. It is highly recommended that young women do start on HRT and continue taking this until the time of the average menopausal age. In the UK, the average age of menopause is 51.
HRT comes in many forms and strengths. Young women may require extremely high doses of HRT to stop their symptoms, with older women often requiring smaller doses.
It is important that women that still have a uterus take a combination of oestrogen and progesterone. Women without a uterus will only require oestrogen replacement.
This is known as combined HRT. Progesterone is given alongside oestrogen to protect the uterus. If oestrogen only was administered, it is possible for the cells lining the uterus to overgrow and in time, this could lead to endometrial cancer.
There are multiple ways of taking HRT, including tablets, skin patches, gels and implants. We advise you to discuss the multiple options with your doctor and primary care team.
ARE THERE ALTERNATIVES TO HRT FOR WOMEN LIVING WITH CANCER?
For women who have had a diagnosis of an oestrogen receptive cancer, there are alternative treatment options that can be considered to manage vasomotor symptoms. For minor symptoms cognitive behaviour therapy (CBT) or optimising lifestyle changes may be sufficient. For moderate to severe vasomotor symptoms, pharmacological interventions such as selective serotonin reuptake inhibitors, pregabalin and gabapentin have been shown in clinical trials to be effective (J.V Pinkerton, R.J Santen. 2019).
There is also so much that can be done for vaginal and bladder symptoms associated with the menopause, lubricants, moisturisers, vaginal dilators and vaginal oestrogens to name a few.
HOW CAN A MENOPAUSE SPECIALIST HELP?
During an initial consultation with a menopause specialist, a medical history will be taken. We will then work together to find possible solutions and treatment options that may help to alleviate symptoms.
A menopause specialist can also help to identify if what you are currently experiencing is actually menopause related. Follow up consultations will be tailored to what the individual needs and we do advise a follow-up at 6 weeks, when booking the initial assessment, so we can gauge whether the treatment path is effective.
Talking with someone who has an understanding of your treatments and the range of symptoms that come with menopausal symptoms, as well as peer groups can be incredibly helpful. Finding practical ways of coping with VMS and being able to reduce the severity, frequency and impact can bring back some much needed control.
ARE THERE ANY PRACTICAL STEPS I CAN TAKE TO EASE VMS?
Absolutely. Here are some suggestions:
Wearing natural fibres allows our bodies to breath and can absorb perspiration, drawing it away from the skin and keeping us cool. Wearing open neck garments like v-necks are a good choice. Having something light to use, like a pashmina, if you’re feeling chilly after a flush can be really effective.
Keep hydrated and carry cold water with you. Try keeping a couple of bottles in the freezer so if you go out you have icy water to sip.
Rethink your exercise. High aerobic exercise is known to contribute to VMS and it may be worth changing up your fitness plan to incorporate a mixture of other movements such as walking early in the morning for longer distances as opposed to running, and adding pilates or yoga into your routine.
Keep an open window and an oscillating fan in the bedroom. Fresh, moving air is very helpful at night. Silk pillow cases are cooling and absorb moisture.
Consider a dietitian. Depending on your overall health and medical history, a dietician may be able to suggest dietary changes that can support your system as well as tackle the common issue of unwanted weight gain and advise if phytoestrogens are appropriate.
Keep a food diary. Note the time you eat or drink something, the time you experience a flash can identify trigger foods or drinks. Being aware of what has triggered the flush can reduce the severity of it.
Aloe vera sprays are a great secret weapon to have in your handbag. A few drops of peppermint essential oil diluted in moisturiser or coconut oil is rated well by some women to keep their skin feeling cool (never use essential oil directly on your skin).
Stay out of the sun in warmer months, and take cool tepid showers when needed.
References
British Menopause Society. “Management of the Menopause”. 2017: https://thebms.org.uk/publications/handbook/
J.V Pinkerton, R.J Santen. “Managing vasomotor symptoms in women after cancer”. Dec 2019: https://pubmed.ncbi.nlm.nih.gov/31081391/
