When Cancer Treatment Causes Menopause: Tips for Preparing and Coping

Dealing with cancer is difficult enough without having to cope with the effects of treatments intended to save your life. While most of those effects are temporary, menopause caused by medical or surgical treatments is a permanent reality.

Most women experience natural menopause, defined as the permanent end of menstruation (and fertility) not caused by any medical intervention. Natural menopause usually occurs at about age 51, and after a gradual transition that can last for years. During this transition, called perimenopause, the ovaries’ production of hormones—including estrogen, progesterone, and androgen—gradually declines, often causing symptoms such as erratic periods, hot flashes, vaginal dryness, difficulty sleeping, and mood swings.

Menopause caused by a medical treatment or surgery is called induced menopause. This can occur at any age prior to natural menopause, and can be the result of surgical removal of both ovaries (called bilateral oophorectomy) or treatments that damage both ovaries, such as certain types of chemotherapy or pelvic radiation used to treat certain cancers. (Note: Hysterectomy does not cause menopause unless both ovaries and the uterus are removed.)

When caused by surgery, menopause occurs immediately, and the abrupt loss of hormones can cause symptoms that are more severe than those experienced with natural menopause. When menopause is caused by medical treatments, there may be a short transition while the ovaries gradually cease production of hormones.

Whether brought about by surgery or medical treatments, induced menopause forces women to deal with a number of emotional, physical, and practical issues—all in addition to the original diagnosis. The following tips will help you to prepare for and cope with induced menopause in the most effective way possible.

1

Be proactive: Before having surgery or beginning any cancer treatment, ask your physician if that treatment will cause menopause. The unknown can be frightening, and knowing what to expect often makes it easier to cope with events when they occur. Furthermore, having this information ahead of time will help you to prepare, both physically and emotionally, while giving you the information you need to make some important life decisions. If, for example, you had hoped to begin or add to your family when you were diagnosed with cancer, referral to a fertility specialist may be appropriate. Depending upon your situation, you may be a candidate for a procedure such as egg harvesting, which can be done before your treatment.

2

Educate yourself: Everyone’s menopause experience is different, and some women still have misconceptions about what menopause is and isn’t. While family and friends can often provide emotional support, it’s best to get your medical information from the experts, especially since expert opinions on menopause and midlife women’s health tend to change rapidly as research findings are reported. When in doubt, ask your physician. When you feel the need for additional information, be sure to get it from a trusted source. One such source is The North American Menopause Society (NAMS, www.menopause.org), a world leader in menopause information and education that offers a wide range of resources, including patient-friendly online information and publications such as the Early Menopause Guidebook. Various cancer-related websites, such as those sponsored by the American Cancer Society (www.cancer.org) or groups associated with your specific type of cancer, may also offer information about induced menopause.

3

Protect your health: After menopause, whether natural or induced, women no longer have the protective effects of ovarian hormones such as estrogen, the loss of which places them at increased risk for certain conditions such as the bone-thinning disease osteoporosis and osteoporotic fractures. Women who experience induced menopause at a young age live without this protection for more years, and are therefore at greater risk for certain diseases. A number of treatments and lifestyle choices can help to prevent many of these diseases, making regular visits to your physicians, including your gynecologist, more important than ever. Be sure to choose physicians who understand the complexities of your cancer diagnosis and are well versed in menopauserelated issues.

4

Don’t settle for symptoms: Menopause-related symptoms can range from annoying to severe. Women who experience symptoms, such as hot flashes and vaginal dryness, sometimes view them as inevitable, not realizing that, in many cases, they can be effectively managed with medications, supplements, dietary and other lifestyle choices, or a combination of all of these. Women who experience induced menopause tend to require treatment for menopauserelated symptoms more often than those who reach menopause spontaneously, and sometimes for longer periods and at higher doses—not only to control symptoms but also to reduce the risk of menopauseassociated diseases later in life. Keep in mind that many nonhormonal medications are available for relieving menopause symptoms and for disease prevention/ treatment for those women unable or unwilling to use hormonal therapies. Choose physicians very familiar with the symptoms of menopause, as well as your type of cancer and your treatments.

5

Ask for help: While many women who experience natural menopause come to accept it as a new phase of life, and even describe a sense of relief from the worries about periods and pregnancy, the emotional consequences of earlier or premature menopause (before age 40) can be very different. Even when not related to cancer, younger women who experience menopause may feel as if they’ve become old before their time or have lost their femininity. For some of these women the reality of being unable to bear children can be devastating. Fortunately, the days when talking about menopause was considered taboo are long gone. Support groups offer the opportunity to share with other women coping with similar situations. Such groups can be found by asking a hospital social worker or searching online. When doing so, look for groups for women of your own age since older women tend to view menopause very differently. When appropriate, involve your spouse or partner.

6

Give yourself permission: People with cancer are often described as strong or even heroic, sometimes making them feel the need to put on a brave face to live up to others’ expectations. Be sure to give yourself permission to feel what you feel, and to grieve, cry, and even fall apart. Finally, keep in mind that asking for help is, indeed, a sign of strength rather than weakness.