Early Menopause and Breast Cancer Treatment
One of the less talked-about side effects of chemotherapy for some women is early menopause. Research suggests that the best predictors of who will have this side effect are the age of the woman and the type of chemotherapy she receives. The average age for natural menopause is 51, and the closer a woman is to this age, the more likely she is to be thrown into menopause by chemotherapy. A 45-year-old has about an 80 percent chance of going into early menopause as a result, while a 35-year-old has about a 20 percent chance.
The end of fertility?
Chemotherapy can bring on menopause by damaging a woman's ovaries and reducing the amount of hormones they make. For women within a decade or so of natural menopause, this change often is permanent, meaning the end of menstruation and fertility. For younger women, though, it may be only temporary. They may find that their periods return after the chemotherapy ends, along with their ability to conceive a child. Breast Cancer Survivor, Tonya says "I was thrown into early menopause temporarily for about 6 or 7 months. Hot flashes and the whole 'shebang'. Not being able to take hormones makes it harder to deal with. Then allof a sudden my period returned...with a vengeance."
If you start having symptoms of menopause while on chemotherapy, it's hard to know which group you're in. Even if your periods become irregular or stop, you still may be able to get pregnant. Since chemotherapy can cause severe birth defects, especially in early pregnancy, it's crucial to use birth control during treatment if you're sexually active.
"The average age for natural menopause is 51, and the closer a woman is to this age, the more likely she is to be thrown into menopause by chemotherapy."
Chemical Change of Life
Early menopause is usually brought on by drugs given during chemotherapy. These drugs can possibly damage the ovaries and permanently stop regular menstrual cycles. This is often only temporary in women ages 40 and under. However for women over 40, it is usually a permanent life change, thus forcing the women into an early menopause.
Like natural menopause, early menopause can be frustrating. Brought on by chemical changes, women experience a wide range of symptoms, including irregular or absent periods, hot flashes, trouble sleeping, mood swings, fuzzy thinking, vaginal dryness, and loss of interest in sex. In fact, the symptoms of this sudden menopause often are more severe than the slow changes that occur naturally. Fortunately, there are several options for treating any symptoms that are troublesome.
The Estrogen Question
One option that is trickier for breast cancer survivors than for other women is hormone replacement therapy (HRT). This involves the use of estrogen and progesterone from an outside source to replace hormones that the body has stopped making on its own. HRT can be very effective for treating menopausal symptoms. However, estrogen nourishes most types of breast cancer, and scientists are concerned that whether taking estrogen increases the risk of getting the disease. To be on the safe side, women who have been diagnosed with breast cancer typically aren't given estrogen. In the past, even long-term survivors were discouraged from using HRT because of fears that it might contribute to a recurrence.
Problems and Solutions
For women who prefer not to use HRT, other options are available. Here are some common menopausal symptoms and possible ways to manage them:
Hot flashes—A hot flash is a sudden feeling of heat in the body that lasts for one to five minutes. It may be accompanied by sweating, flushing, or a racing heart. To control hot flashes, you can try to stay away from hot places, wear cool clothes, avoid spicy foods, and minimize stress as much as possible. Medications, such as megestrol (Megace), clonidine (Catapres), and certain antidepressants, also may help. In addition, soy has been much-touted lately as a natural way to manage hot flashes. Soy and soy-based foods contain substances that act like estrogen in some organs while blocking estrogen in others. While soy may have beneficial effects, there also is a possibility that high doses might promote the growth of breast cancer. The American Cancer Society says breast cancer survivors should avoid concentrated sources of soy, such as pills and powders.
Sleep problems—Some women have trouble sleeping due to night sweats, a nighttime variant on hot flashes in which women wake up drenched in sweat. Night sweats usually improve once hot flashes are treated. However, not all menopausal sleep problems are accompanied by night sweats. In such cases, it may help to exercise in the morning and avoid caffeine, alcohol, and heavy meals in the afternoon and evening. Also, go to bed at the same time each night, and make sure your bedroom is dark, quiet, and comfortable. Use your bedroom only for sleeping and sex, not watching the late-late show.
Mood swings—Some women have sharp mood swings or deep feelings of depression around the time of menopause. For milder mood changes, it may help to talk about your feelings, exercise regularly, learn ways to reduce stress, and join a support group. For more severe or long-lasting changes, you may want to consult your doctor or a mental health professional. Medications, counseling, or both are often very helpful.
Fuzzy thinking—Other women are bothered by forgetfulness and trouble concentrating around the time of menopause. The simplest way to deal with this problem is to wait for it to go away on its own, since it usually doesn't last long. You also can try using a written daily schedule and reminder lists to keep your life on track. In addition, taking on a mental challenge, such as enrolling in a college course, solving crossword puzzles, or researching your family history, can give your brain a boost.
Vaginal dryness—Menopausal women often have problems with vaginal dryness and itching. The drop in estrogen levels also can make the tissue that lines the vagina thinner and more fragile. As a result, intercourse can become uncomfortable. Lubricants and moisturizers made especially for the vaginal area may help. If they aren't enough, use of an estrogen cream or a vaginal estrogen ring can be very effective at treating vaginal dryness while having less effect on the rest of the body than estrogen taken by mouth.
Loss of interest in sex—Even after vaginal problems are treated, however, some women still lose their urge to have sex at this time of life. For milder problems, it may be enough to talk frankly with your partner about your feelings and make an extra effort to bring more romance into your relationship. For more severe problems, doctors sometimes give women low doses of male hormone, which increases desire in both sexes. If your doctor recommends this treatment, be sure he prescribes a type of male hormone, such as fluoxymestrone, that can't be converted into estrogen in the body. If sexual problems persist, you also may want to consult a mental health professional or certified sex therapist.
More resources
American College of Obstetricians and Gynecologists http://www.acog.org. This professional society has published a statement on HRT in women with previously treated breast cancer. http://www.medem.com
North American Menopause Society http://www.menopause.org. This scientific organization provides information on the symptoms of menopause and various ways to manage them.
SusanLoveMD.com http://susanlovemd.com. The author of Dr. Susan Love's Breast Book is the founder of this website, which includes a helpful section on how breast cancer survivors can deal with the symptoms of menopause. https://www.drsusanloveresearch.org/act-love-start-today
Sources
Love, Susan M., with Karen Lindsey. Dr. Susan Love's Breast Book, 3rd edition. Cambridge, MA: Perseus Publishing; 2000.
American Cancer Society. A Breast Cancer Journey: Your Personal Guidebook. Atlanta, GA: American Cancer Society; 2001. SusanLoveMD.com. Available at: http://www.susanlovemd.com
American College of Obstetricians and Gynecologists. Hormone replacement therapy in women with previously treated breast cancer. November 1999. Available at: http://www.medem.com
Hormone Foundation. Available at: http://www.hormone.org
Parts of this document have been edited by Lillie D Shockney, RN., BS., MAS, Administrative Director, Johns Hopkins Breast Center
