Menopause occurs naturally as women age, usually when a woman reaches her early 50s. Menopause is caused by reduced levels of hormones produced by the ovaries, mainly estrogen and progesterone. Menstrual periods become irregular until the amount of estrogen becomes so low that a woman's periods stop completely. Women treated for some types of cancer may experience early menopause as a side effect of some cancer treatments. This is known as treatment-induced menopause.
Causes
Surgery
Women who have surgery to remove both ovaries (oophorectomy) will experience menopause.
Chemotherapy
Some chemotherapy drugs can stop normal ovarian function, which can lead to menopause. This depends on many factors, such as the type and dose of drug used, the length of treatment and most importantly, the woman's age. For example, women who are within several years of natural menopause are more vulnerable to chemotherapy damage and ovarian failure is more likely to be permanent. In younger women, periods may return after treatment is completed.
Radiation therapy
Ovarian function can be affected if radiation therapy is given to the pelvis. This depends on the woman's age and the dose of radiation to the ovaries. The effect may be temporary or permanent.
Hormonal therapy
Some hormonal therapies can cause menopausal symptoms, such as changes in menstruation and hot flashes, but do not cause treatment-induced menopause. These include:
- anti-estrogen drugs such as tamoxifen (Nolvadex)
- aromatase inhibitors such as anastrozole (Arimidex)
- luteinizing hormone releasing hormone (LHRH) drugs such as goserelin (Zoladex) or leuprolide (Lupron, Lupron Depot)
Men taking anti-androgen (androgen blocker) drugs such as flutamide (Euflex) and LHRH drugs can also experience hot flashes.
Symptoms
Each woman will experience menopause differently. Its symptoms are the same if it occurs naturally or if it is brought about by cancer treatment. Not all women will have all of these symptoms:
- hot flashes
- night sweats
- problems sleeping, such as not being able to fall asleep (insomnia)
- weight gain
- vaginal dryness or vaginal itching
- some loss of bladder control
- more frequent bladder infections
- mood swings or irritability
- problems with memory and concentration
Long-term effects of menopause include:
- loss of bone mass or density and eventual osteoporosis
- changes in cholesterol levels and greater risk of heart disease
Diagnosis
The doctor will ask a woman when her last menstrual period was and about any menopausal symptoms. Generally, women who have not had a menstrual period for more than 12 months are considered to be menopausal.
Blood tests can be used to measure hormone levels that may show when a woman is close to menopause or has already gone through menopause. Examples of these tests include checking the level of:
- estradiol – the main estrogen made by the ovaries
- follicle-stimulating hormone (FSH) – a hormone that controls estrogen production by the ovaries and stimulates a woman's eggs to grow and mature
- luteinizing hormone (LH) – a hormone that causes the ovary to release estrogen and helps regulate menstrual periods and egg production (ovulation)
Managing menopausal symptoms
Some measures that may be helpful for relieving menopausal symptoms include:
To relieve hot flashes
- Wear light clothing in layers.
- Splash cool water on the wrists.
- Some women find vitamin E supplements help ease hot flashes and may help with sleep.
- Ask the doctor if vitamin E supplements are suitable and about the dosage and how often to take vitamin E.
- Some medications that may be ordered to help reduce hot flashes include:
- clonidine (Dixarit, Catapres) – a drug used to treat high blood pressure
- venlafaxine (Effexor) – an antidepressant
- paroxetine (Paxil) – an antidepressant
- fluoxetine (Prozac) – an antidepressant
- gabapentin (Neurontin) – an anticonvulsant (antiseizure) medication
To help with sleep
- Drink warm milk, chamomile tea or teas that contain valerian at bedtime. Avoid alcohol and caffeine as they can make menopausal symptoms worse.
- Include regular physical activity during the day to help relieve stress and improve overall well-being. Try relaxation techniques before bed to help you relax.
To help deal with mood swings, irritability or anxiety
- Try different relaxation techniques, such as visualization, deep breathing, massage or yoga to help lower stress levels.
To relieve vaginal dryness
- Use a water-based lubricant (a vaginal moisturizer) during sex.
- Regular sexual activity may prevent dryness.
- Ask the doctor about using a vitamin E vaginal suppository or vaginal cream to relieve symptoms.
To prevent bladder infections and improve bladder control
- Drink lots of fluids.
- Empty the bladder frequently (especially after having sex).
- Wear cotton underwear.
- Keep the genital area clean.
- Try Kegel exercises to improve bladder control – these exercises use the same muscles that stop the flow of urine during urination.
- Exercises can be done in a sitting, lying or standing position.
- Concentrate on drawing in or tightening the muscles around the anus – do not contract the abdominal, back or thigh muscles.
- Hold this squeeze for 10 seconds and then release slowly (some suggest thinking of an elevator going up to the 10th floor and then coming back down).
- Repeat several times.
- Try to do a set of Kegel exercises every hour while awake.
Herbal therapies
Some women choose to use different herbal therapies to relieve menopausal symptoms. There has not been enough research on the effectiveness and safety of herbal therapies for women with cancer experiencing menopause. Some substances may interfere with treatments or may be harmful, so always check with your doctor before taking any herbal products.
- soy products – contain weak plant estrogens (phytoestrogens)
- It is not certain what effect phytoestrogens have in women with certain types of hormone-related cancers such as breast or ovarian cancer.
- Until more is known, women with hormone-related cancers should not take concentrated soy products that may contain a large amount of soy.
- One recent study showed that soy protein did not do any better than a placebo at reducing the severity or frequency of hot flashes.
- evening primrose oil
- ginseng
- black cohosh
Hormone replacement therapy
Hormone replacement therapy (HRT) is sometimes used to manage the symptoms of menopause such as hot flashes, problems sleeping and mood swings. The combination of an estrogen plus progestin (combined HRT) is used more often, because estrogen alone can cause cancer of the uterus (endometrial cancer) and ovary. Progestin appears to protect against the development of endometrial cancer in women with a uterus but it does not appear to protect against the development of ovarian cancer.
Although combined hormone replacement therapy may help to relieve menopausal symptoms, protect against loss of bone density (osteoporosis) and reduce the risk of colon cancer, research now shows that long-term use of combined HRT also increases the risk of breast cancer, ovarian cancer, heart disease, stroke and blood clots in the lung (pulmonary embolism).
In addition to endometrial cancer and ovarian cancer, estrogen-only HRT increases the risk of stroke.
Researchers now believe that the risks of long-term HRT use outweigh the benefits. Women should avoid taking HRT for any other reason other than to relieve severe menopausal symptoms that have not responded to any other treatment. Women should discuss the risks and benefits of HRT with their doctor. If you and your doctor decide that taking HRT is right for you, it should be used at the lowest dose and for the shortest period of time possible to control symptoms. Many women feel that HRT is not a good choice for them.