by Kathy Steligo
Most women experience natural menopause when their ovaries stop making estrogen and their periods cease. This “change of life” usually occurs in a woman’s early 50s, but certain types of chemotherapy (also pelvic radiation, hysterectomy or removing your ovaries before natural menopause) can cause menopause regardless of your age.
Chemotherapy-induced menopause in women under age 40 is sometimes temporary; it is more often permanent in older women. Symptoms of early menopause are the same as those that occur with natural menopause, but are more abrupt and often more severe. If you’re facing early menopause, here’s what you may experience and what you can do about it:
Hot Flashes
Unpredictable, intense body heat and perspiration can occur at any time of the day or night, so being prepared is your best weapon. Avoid hot or spicy dishes, alcohol, caffeine and activities that trigger your hot flashes. Dress in layers and avoid turtleneck sweaters, at least until your symptoms subside, as they eventually do. Tuck Cleavage Coolers, small cooling gel packs, inside your bra. Keep a window open or a fan by your bed to minimize night sweats (hot flashes while you sleep), and tuck a cooling Chillow® into your pillowcase. Exercise, yoga and meditation combat stress, which can also trigger hot flashes. Don’t depend on herbal supplements; they’re unregulated, unproven and may adversely interact with other medications. Concentrated soy isn’t recommended for survivors because it contains plant estrogen that can mimic natural estrogen and potentially promote new tumors. Some antidepressants reduce the frequency of hot flashes; however some (not all) also interfere with the body’s ability to metabolize tamoxifen.
Vaginal Dryness
As estrogen levels decline, so does vaginal moisture. Over time, vaginal tissues can become dry and fragile, making intercourse uncomfortable or painful. Over-the-counter vaginal lubricants can help, and having sex regularly helps you to secrete more natural moisture. Avoid douches or soap, which tend to be drying. If dryness continues, ask your doctor about low-dose vaginal cream or the Estring® estrogen ring.
Decreased Libido
Although many women continue to enjoy sexual intimacy during menopause, others notice a definite decline in sexual desire. First, understand the underlying cause: no one feels sexy when they’re fatigued, worried or suffering from hot flashes. Speak openly with your partner; you may need to change your approach to intimacy to get the result you want. If all else fails, consider a visit to a sexual dysfunction expert. Some physicians prescribe testosterone supplements to improve libido; however, it is not FDA-approved for that purpose and it’s unclear whether it is safe for survivors.
Insomnia
When night sweats, fatigue and other menopausal symptoms get in the way of a good night’s rest, avoid meals and exercise three hours before bedtime and cut down or eliminate alcohol and caffeine. Try to get to bed at the same time each night. If you can’t sleep after 15-20 minutes, read or do something that makes you drowsy. If needed, ask your doctor about short-term medication or consult with a sleep disorder clinic. Valerian (short-term use appears to improve sleep with few side effects) and kava (causes liver damage and should be avoided) are popular but unregulated sleep aids.
Weight Gain
Although maintaining a healthy weight and lean muscle is important throughout life, it can be especially difficult during menopause. Cardiovascular exercise and strength training are particularly valuable if you’re menopausal, because they help you lose extra pounds, build muscle and protect bones and heart. Yoga is also advantageous, improving hot flashes, mood swings, fatigue and increasing flexibility.
Mood Swings and Depression
Declining hormone levels and dealing with menopausal symptoms can cause emotional ups and downs without any apparent reason. If this describes your experience, try regular exercise and other stress-reducing activities—they can work wonders for an erratic mood. If you’re depressed or your feelings interfere with your normal life, a mental health professional can help determine underlying causes and suggest ways to get you back on track.
Reduced Memory and Concentration
Many women say they have trouble remembering things and concentrating during menopause, similar to the “chemo brain” described by many breast cancer patients. The good news is that this is usually temporary. In the meantime, engage your mind with reading, puzzles and other brain-challenging activities and get at least eight hours of sleep.
Loss
of Fertility
For many women, no longer having to worry about birth control is welcome news, unless you want to become pregnant in the future. See "Life In the Shadow of the Pink Ribbon", our accompanying essay about fertility after treatment.
Early menopause can cause heart and bone concerns later in life, because after menopause, you have decades ahead of you without the benefits of estrogen. Women who haven’t had breast cancer can consider hormone replacement therapy as a short-term remedy for their symptoms. For survivors, the risks of estrogen replacement probably outweigh the benefits, because it can stimulate new tumors, so it’s important to take protective actions. Walk, jog or do other weight-bearing exercise for at least 30 minutes a day, three days a week to benefit both your bones and your heart. Get sufficient calcium and vitamin D each day and have a biennial bone density test. Both tamoxifen and raloxifene help prevent future breast cancers and are beneficial to bones. Non-hormonal bisphosphonates preserve bone density and build new bone (be sure you understand the advantages and disadvantages). Ask your doctor whether any of your medications affect bone loss, and avoid or strictly limit alcoholic beverages and don’t smoke.
Despite the many fears about menopause, not all women have symptoms, and many who do don’t need medication. Let your own experience be your guide. Try lifestyle changes and non-hormonal treatments, giving yourself time for trial-and-error to discover what works best. If your symptoms persist or affect your quality-of-life, talk to your doctor about potential solutions given your survivor status.