Most women naturally go into menopause when they’re in their 40s or 50s. That’s because as a woman ages, she has fewer reproductive eggs and her estrogen and progesterone levels decline. After 12 months of not having a menstrual cycle, she’s considered to be in menopause.
But for women undergoing breast cancer treatment, menopause can start earlier and feel more extreme.
Typical menopausal symptoms include hot flashes, mood swings and weight gain. Some women also experience changes in their metabolism and cholesterol levels.
Here are seven things women with breast cancer should know about menopause.
Chemotherapy can cause temporary menopause
Chemotherapy fights cancer by attacking any rapidly growing cells. Women receiving chemotherapy – regardless of the type of cancer they’ve been diagnosed with – are at risk of the drugs attacking the ovaries. “Chemotherapy basically puts the ovaries to sleep,” Lim says. The ovaries stop processing the eggs, the woman stops having a period and she goes into temporary menopause.
In most cases, menstruation returns naturally eight months to two years after chemotherapy stops. However, research shows that women who experience temporary menopause during treatment tend to go into complete menopause earlier than others. “But it really depends on the patient,” Lim adds.
However, if a woman is already nearing menopause, chemotherapy may put her into complete menopause and her period may never return.
Talk to your doctor if you’re concerned about whether your menopausal symptoms are permanent. “Bloodwork can help us understand what’s happening and prepare you for the future,” Lim says.
Temporary menopause can help preserve fertility
If a woman is hoping to get pregnant after treatment, temporary menopause can help preserve fertility by protecting the eggs during chemotherapy.
Younger patients may have the option of taking medications to begin temporary menopause before starting chemotherapy. “It's the same concept as when you put food in the refrigerator to preserve it for a while,” Lim says. “We’ll put the eggs into a frozen-like state so they can stay fresh without getting attacked by chemotherapy.”
Treatment-related menopause can feel more extreme
Menopausal symptoms can seem more exaggerated in breast cancer patients. When it occurs naturally, menopause takes a few years from the time your period gets interrupted to the time it completely stops. But cancer treatment can speed up the process so that it takes only a few months.
“Because they come on so quickly, patients can have a harder time coping with the symptoms,” Lim says.
The level of hormones in younger patients is also much higher at the start of menopause, so the symptoms can feel much more extreme, Lim adds.
Hot flashes are linked to hormone therapy
About 60% to 80% of breast cancers are fueled by estrogen or progesterone. These are known as hormone receptor-positive breast cancers. Some ovarian and uterine cancers are also linked to these hormones.
During your period, hormone levels spike, and any estrogen or progestogen signal in the body can wake up the cancer cells and lead to a recurrence, sometimes even decades later.
To help lower hormone levels after cancer treatment, many women undergo hormone therapy. Also known as endocrine therapy, it works by either blocking the hormones or by preventing the body from making them. Examples of hormone therapies include tamoxifen, raloxifene, ovarian suppression injections and aromatase inhibitors. These medications are typically taken for five years.
For many women, hormone therapy can speed up menopause and its symptoms. “Almost half of women on these therapies experience related hot flashes,” Lim says.
Menopause helps lower recurrence risk
If you have a high risk of breast cancer recurrence, your doctor may recommend inducing menopause by surgically removing the ovaries or with medications that train your body to stop the menstrual cycle.
“We try to do everything we can to limit the risk of recurrence, so if we reduce hormones, we cut off the food for the cancer cells,” Lim says.
Menopause has drawbacks for cancer survivors
There are downsides to menopause, too. In addition to the common menopausal symptoms, low estrogen levels can affect bone density and heart function. But there are steps women can take to manage these side effects.
“It’s a give and take, but for most women, lowering their cancer risk outweighs the discomfort of menopause,” Lim says.
Medications and lifestyle changes can offer relief
There are several ways to cope with menopausal symptoms, says Lim. The first approach is medication. A low-dose antidepressant can help with hot flashes and mood swings.
Lifestyle modifications can help, too. For example, Lim recommends you get a good night’s sleep, exercise regularly, and reduce caffeine and alcohol intake.
“It’s hard, but everything in moderation is the best approach,” Lim says. “And this healthy approach can help keep the cancer from coming back because it reduces your fat and increases your muscle mass, which can lower the level of estrogen in your body.”
It can also help to keep a diary of when you feel menopause symptoms. “This lets us anticipate them and have the tools ready to help you cope,” Lim says.
She advises talking with your doctor about anything unusual that you’re experiencing. “Even if it's silly and you don’t know if it’s a relevant, it’s better to share more than less,” Lim says. “That way, we can help you feel as normal as possible.”
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