Menopause

Overview

Chemotherapy may cause ovarian failure leading to premature menopause, which is the end of menstruation. Ovarian failure may be temporary or permanent. Hot flashes (sensations of heat with redness, flushing and sometimes sweating) are a common and disturbing symptom of menopause. Talk to your doctor about menopause and what can be done to manage the symptoms.

What is menopause?

Menopause is the end of menstruation. It is usually confirmed after 12 consecutive months have passed without a menstrual cycle. While this is the definition of menopause that your doctor uses, menopause is also understood in terms of the many physical changes that a woman experiences either before or after menstruation stops.

What causes menopause?

Menopause is a natural event in every woman’s life. For cancer patients, menopause can occur prematurely. Cancer treatments, such as chemotherapy or radiation therapy, may cause premature menopause by damaging the ovaries and decreasing production of estrogen and other female hormones. These hormones regulate the menstrual cycle; without them, the body no longer releases eggs from the ovaries and the menstrual cycle stops.

Premature menopause as a result of cancer therapy usually comes on gradually and can be temporary or permanent. Return of ovarian function depends on the woman’s age before treatment and the type of chemotherapy drug used. Ovarian failure as a result of chemotherapy has been shown to benefit some women with localized breast cancer. Many studies have shown that young women with breast cancer who develop ovarian failure after chemotherapy have fewer recurrences than women who have permanent ovarian failure.[1]

What are the symptoms of menopause?

Symptoms of menopause vary from person to person. However, because premature menopause occurs more suddenly than natural menopause, symptoms may be more severe. Possible menopausal symptoms include:

  • Hot flashes (sensations of heat with redness, flushing and sometimes sweating)
  • Mood changes (mood swings, depression, irritability)
  • Sleep problems
  • Vaginal dryness
  • Urinary problems, including burning or pain when urinating, or leaking when sneezing, coughing or laughing
  • Problems with concentration or memory
  • Less interest in sex and changes in sexual response
  • Weight gain
  • Thinning or loss of hair

How is menopause managed?

Common approaches to managing the symptoms of menopause include hormone replacement therapy, prescription antidepressant drugs, soy, and the herb black cohosh.

Hormone replacement therapy (HRT): Symptoms of menopause can be managed through hormone replacement therapy (HRT) with estrogens and progesterone.  However, this may not be an option for patients with breast or endometrial (uterine) cancers because the hormones may stimulate cancer growth. Furthermore, HRT is associated with risks. Talk to your doctor about whether HRT could be an option for you.

Antidepressant medication: Medications for depression are a non-hormonal approach that may be beneficial for some women. A clinical trial has demonstrated that the antidepressant venlafaxine (Effexor®) can suppress hot flashes. The study involved 222 women who tracked the number of hot flashes they had while taking venlafaxine. Women who took 75 milligrams (mg) a day had a 61% reduction in the number of hot flashes they experienced.[2] Fluoxetine (Prozac®) may also provide relief for some women.

Soy: Soy products may provide some relief. Soybeans contain phytoestrogens, which are estrogens found in plants. Isoflavones are one kind of phytoestrogen and are plentiful in whole-soy foods. These compounds behave like weak forms of your body’s own estrogen.

Black cohosh: The herb black cohosh is approved in Germany for the treatment of hot flashes. It has been used to relieve some symptoms of menopause. However, since this herb has estrogen-like properties, its safety in patients with breast cancer has not been confirmed. Also, preliminary laboratory results suggest that black cohosh may increased the potency of certain chemotherapy drugs, including doxorubicin (Adriamycin®) and docetaxel (Taxotere®). Remember to tell your cancer doctor about any medication or alternative medicine treatments that you are taking.

What can I do to manage the symptoms of menopause?

Remember to talk to your doctor about any symptoms or side effects of cancer treatment that you are concerned about. Also, try these tips for managing symptoms of menopause:

  • Limit spicy food, alcohol and caffeine, all of which can trigger hot flashes.
  • Use a water soluble lubricant such as KY Jelly to relieve vaginal dryness.
  • Exercise daily to relieve emotional symptoms.

References

[1] Adjuvant hormonal therapy for premenopausal women with breast cancer. Emens LA, Davidson NE.Clin Cancer Res. 2003;9(1 Pt 2): 486S-94S.)

[2] Barton D, Loprinzi C, Wahner-Roedler D. Hot flashes: aetiology and management. Drugs Aging. 2001; 18(8): 597-606.

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