Menopause after cancer

Last updated 29 June 2017 — Last reviewed 03 March 2014

Having menopause and cancer at the same time can be very distressing. Managing your health, your illness and menopause at the same time is difficult given that your treatment options for menopause are often limited, however there are many things you can do to help.

woman being treated for cancerMenopause and cancer are associated for a number of reasons:

  • Cancer treatment (chemotherapy and/or radiotherapy) can cause ovaries to fail and you start menopause
  • Hormone therapies (such as Tamoxifen and aromatase inhibitors) used to treat breast cancer can cause menopausal symptoms

Studies show 25% of women who develop breast cancer are not menopausal, this means they may experience menopause sooner than they would otherwise have done.

It's also possible that:

  • you may be in menopause when diagnosed with cancer
  • stopping hormone replacement therapy (HRT), when your cancer diagnosis is made, can bring on menopausal symptoms that may have been otherwise masked by HRT

Breast cancer is the most common cancer affecting women, so much of the information and research about cancer and menopause relates to breast cancer. But treatment for other cancers (including childhood cancers, non-hormonal cancers and hormonal cancers) can also result in menopause.

Not all cancer treatments will cause menopause. For some women menopause symptoms are temporary, for others menopause is permanent.  Sometimes periods will stop straight away and sometimes menopause symptoms will start immediately or build up over time. There is no way of predicting how menopause will affect each woman. Whether permanent menopause occurs depends on age, the type and dosage of chemotherapy and how long it is used for.

Symptoms

It is sometimes difficult to distinguish between what are 'normal' menopausal symptoms and which symptoms are made worse because of the cancer.

Symptoms experienced by menopausal women with breast cancer

Research suggests young menopausal women with breast cancer may experience the following:

Hot flushes & night sweats

  • up to 80% of women with breast cancer seem to experience more severe and frequent hot flushes compared with women without breast cancer[1]
  • night sweats and hot flushes tend to vary with the type of breast cancer treatment and can contribute to insomnia in women with breast cancer

Urogenital symptoms

50-75% of women with breast cancer report one or more symptoms – e.g. vaginal dryness, itching, painful sex, urinary tract infections; especially those taking aromatase inhibitors which reduce the risk of recurrence of breast cancer.

Emotional/mental health

Increased depression and anxiety can be related to being diagnosed with a major illness. They are also affected by:

  • age
  • the stage of the cancer
  • how well treatment is going
  • how well you can cope with what is happening
  • the support you have

Early menopause

Younger women with breast cancer can experience more physical symptoms, psychological distress and poorer sexual functioning compared to other (older) women with breast cancer. More information is available on early and premature menopause.

Hormone therapy

Medications such as Tamoxifen and aromatase inhibitors are often given to women who have oestrogen dependent cancers. These medications are oestrogen suppressors and can cause menopausal symptoms like hot flushes, vaginal dryness and changes to bone density. Up to 20% of women with breast cancer consider or stop hormone therapy because of their menopausal symptoms.  If you are taking these medications and menopausal symptoms are really troubling you, please discuss this with your doctor.

Management & treatment of symptoms

Managing menopause in women with cancer involves a number of options:

  • Lifestyle changes, which can help reduce depression, anxiety, cardiovascular and osteoporosis risks
  • Natural therapies (although evidence on their effectiveness is limited)
  • Psychological support
  • Medication

See management for more information.

Healthy living

Having a healthy diet containing a variety of fresh foods can help you cope with menopause symptoms.  The increased tiredness and moodiness of menopause along with having cancer can often make it difficult to eat a healthy diet. It can take time to organise healthier food choices and you may not always feel like making the effort.

Physical activity of 30 minutes per day can help reduce stress, improve mood, increase your ability to cope with daily life and this can help you cope with menopause symptoms. Depending on where you are up to in your treatment for cancer, gentle exercise and fresh air can help you through the day.

More information about ways to have a healthy diet and physical activity is in our Healthy living webpages.

Natural & complementary therapies

Because women with hormone dependent cancers are usually not able to use HRT, and they are suffering severe symptoms, it is valuable to know which alternative treatments are safe.

There is inconsistent research on herbal and natural therapies specifically for women with breast cancer and menopause.  Some herb and plant therapies can have side effects and interact with medications. If you are using herbal therapies or thinking about using them, please let your doctor know so you can explore any possible risks.

Relaxation, cognitive behaviour therapy & mindfulness

Training in relaxation skills can help you cope with the stress and the severity of hot flushes.

Cognitive behaviour therapy (CBT) helps with how you think about the things happening to you, and also trains you to watch and change how you behave when you are worried or upset. CBT has been found to help reduce the severity and number of hot flushes in menopausal women with breast cancer.[1] If you would like more information on CBT please go to the anxiety toolkit webpages.

Mindfulness training has also been shown to reduce the frequency and severity of hot flushes.[2] Mindfulness involves paying attention in the present moment to bodily sensations and thoughts and helps you learn to not get so caught up in your thinking.  By becoming aware of the different sensations in your body and bringing attention to your thinking and feelings through mindfulness training, it has been shown that in women with breast cancer, stress reduces and overall quality of life improves.[3]

Hormone replacement therapy

Women with oestrogen dependent cancers, including some types of breast and high-risk endometrial cancer, should generally not use hormone replacement therapy (HRT). Whether to use HRT is a decision to make in consultation with your oncologist and doctor.

Tibolone & breast cancer

Tibolone (sold as Livial) is a synthetic hormone and its actions are similar to oestrogen, progesterone and testosterone. Tibolone is often mentioned when discussing possible hormone therapy for women with breast cancer.

It may help to improve mood, help you sleep better, decrease hot flushes and improve general wellbeing. Tibolone may also help sex drive by improving vaginal secretions, increasing free testosterone and mood.  However, while Tibolone (Livial) is not associated with an increased risk of breast cancer, in women without breast cancer, the multinational study of women with menopause symptoms and breast cancer showed that Tibolone increased the risk of reoccurrence compared to placebo.[4]

It should be noted that Tibolone may interfere with the effectiveness of breast cancer therapies and it is therefore not recommended for women with breast cancer.[5]

Antidepressants

For women not able to use hormone based treatments for menopausal symptoms, a group of antidepressants called SSRIs/SNRIs (selective serotonin or serotonin-norepinephrine reuptake inhibitors) are sometimes used as they have been found to be helpful in reducing hot flushes. Some antidepressants can interfere with other medications such as tamoxifen. Your doctor can work out whether an antidepressant is suitable for you. These medications can help you cope, so please ask your doctor about them.

Mental & emotional health

The combination of coping with a cancer diagnosis, undergoing treatment as well the impact of managing menopausal symptoms may be an overwhelming experience. Managing and maintaining your emotional wellbeing is an important aspect of your overall health and wellbeing.

Fertility & chemotherapy  

Before chemotherapy and/or radiotherapy, you should investigate your options for trying to preserve eggs for conception.  There are a number of options including:

  • egg preservation
  • embryo freezing
  • ovarian preservation
  • ovarian biopsy and freezing

Egg preservation

This takes place before chemotherapy.

The ovaries are hormonally stimulated to produce eggs and the eggs are then collected.

If you have a male partner, the eggs can be fertilised with your partner's sperm and the embryos are then frozen. When you are ready for pregnancy, the embryos are transferred into the uterus.

If you do not have a partner, the unfertilized eggs may be frozen. When you are ready for pregnancy, the eggs are thawed and a male partner's sperm or donor sperm is used to fertilise them. (This technology is still in development and the success is limited).

Ovarian preservation

Some women are given therapy with a GnRH agonist – a hormone that causes a chemical to suppress the ovary and eggs temporarily. This therapy is given during chemotherapy. After the chemotherapy stops, the GnRH agonist stops and the menstrual cycle should return. This therapy is not well developed or researched.

Ovarian biopsy & freezing

This procedure takes place before chemotherapy starts. A piece of ovary is excised (cut away) and frozen. After the chemotherapy is complete, the ovarian tissue is transplanted under skin and with hormone stimulation, eggs are collected. This technique is still in the research phase.

What can you do to manage symptoms?

Keep a record of the symptoms troubling you the most and list:

  • how frequent the symptoms are
  • how severe the symptoms are
  • the effect they have on your daily life

Use this information to see what changes to consider to reduce the impact of these troubling symptoms.

Seek information from a trusted source such as the Breast Cancer Network Australia's 'My journey kit' or visit bcna.org.au

Seek advice from your doctor.

Visit a psychologist who specialises in emotions in chronic illness. Medicare rebates are available for up to 10 visits per year to a psychologist. Talk to your doctor about this.

 

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References

  1. Schover LR. Premature ovarian failure and its consequences: vasomotor symptoms, sexuality and fertility. J Clin Oncol. 2008 Feb10;26(5):753-8.

  2. Sayakhot et al. Potential adverse impact of ovariectomy on physical and psychological function of younger women with breast cancer. Menopause, 2011 Mar 14;18(7): 786-793.

  3. Mann et al. Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment: a RCT. Lancet Oncology. Pub online Feb 15, 2012 DOI:10.1016/S1470-2045(11)70364-3 1

  4. Carmody et al. Mindfulness training for coping with hot flashes: Results of a randomized trial. Menopause. 2011 June; 18(6): 611–620.doi: 10.1097/gme.0b013e318204a05c

  5. Henderson et al. The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: a randomised trial. Breast Cancer Res Treat. 2012 Jan;131(1):99-109. doi: 10.1007/s10549-011-1738-1. Epub 2011 Sep 8.

  6. Kenemans P, et al. A double-blind, randomised non-inferiority trial. Safety and efficacy of tibolone in breast-cancer patients with vasomotor symptoms: a double-blind, randomised, non-inferiority, trial. Lancet Oncology 2009; 10(2); 135-46 Ebup 2009 Jan 23. http://www.ncbi.nlm.nih.gov/pubmed/19167925)

  7. Cummings SR, Ettinger B, Delmas PD, et al. for the LIFT Trial investigators. The effects of tibolone in older postmenopausal women. N Engl J Med 2008;359:697–708 (http://content.nejm.org/cgi/content/abstract/359/7/697)

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at March 2014.

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