Menopause and Chemotherapy
Cancer and its treatment will undoubtedly cause changes in your life. One change you may experience from chemotherapy is the development of the symptoms of menopause.
How chemotherapy impacts the onset of menopausal symptoms is not fully understood, but this document may begin to answer some of the questions you may have, including:
- How will I know if the way I am feeling is associated with menopause and not with my treatment, stress or another factor?
- What are the symptoms of menopause and how can I deal with them?
- Will chemotherapy affect my ability to get pregnant?
- How does chemotherapy cause or contribute to the development of menopause?
- What are some other conditions related to menopause?
What is menopause?
Menopause is a normal stage in a woman's life. The term menopause is commonly used to describe any of the changes a woman experiences either before or after she stops menstruating. As menopause nears, the ovaries produce less estrogen, causing changes in the menstrual cycle and other physical changes. Technically, menopause is the end of the reproductive period in a woman, when the ovaries no longer produce eggs and she has her last menstrual cycle. The diagnosis of menopause is not confirmed until a woman has not had her period for 12 consecutive months.
How does chemotherapy influence the onset of menopause?
During chemotherapy, women may have irregular menstrual cycles or amenorrhea (disappearance of menstrual periods). Some medications used in chemotherapy may also cause damage to the ovaries, resulting in menopausal symptoms as well as premature menopause.
Menopause may be immediate or delayed, permanent or temporary when triggered by chemotherapy. Unfortunately, there is no way to accurately determine how or when chemotherapy or other cancer treatments will affect your menstrual cycle. However, menopause is rarely a sudden response to chemotherapy. When chemotherapy treatments begin, you may notice some menopausal symptoms, but usually the symptoms are delayed for several months. The older a woman is when receiving chemotherapy the more likely chemo will induce menopause.
Will my menstrual flow be different after chemotherapy?
Menstrual cycles vary from woman to woman. Some women may experience less frequent cycles than they had prior to chemotherapy. They may skip a period or increase the number of days between periods. Other women may have more frequent periods. Some women may not experience a change in the length of their menstrual cycles but the flow pattern may be different than it was before treatment (the number of days or amount of flow may diminish or the flow may be heavier). Mixed patterns are also common: some women may have shorter menstrual cycles with heavier bleeding or infrequent cycles with many days of a very high flow.
Even though periods tend to be irregular around the time of menopause, it is important to be aware of bleeding that is not normal for you. It is very important to call your physician if you ever have very heavy bleeding that is associated with weakness or dizziness.
Will my periods return after chemotherapy?
Many pre-menopausal women retain or recover ovarian function and their periods return after treatment is completed. Return of ovarian function may depend on the woman's age prior to treatment and the type of medication she received during treatment. Generally, as a woman ages and becomes closer to menopause (chronologically), the more likely it is that she will experience menopause symptoms during chemotherapy, and the more likely that menopause will be permanent.
Can I get pregnant while I'm receiving chemotherapy?
Yes. There is always a chance that you can get pregnant as long as you are menstruating. While on chemotherapy, your menstrual cycle may become irregular. As a result, you may never quite be sure where you are in your menstrual cycle and your period may take you by surprise. Some of your menstrual cycles may be non-egg producing, but you cannot rely on this. Even if your periods seem to have stopped, you should use a safe and effective method of birth control for at least 2 months after your chemotherapy treatment has ended.
What is the safest type of birth control during chemotherapy?
Irregular menstruation or the disappearance of menstrual periods may persist for years after chemotherapy, making an effective and safe contraception (birth control) method necessary. Women undergoing chemotherapy may decide to use barrier contraceptives such as a diaphragm or a condom. Hormonal contraceptives (birth control pills, patch and vaginal ring) may be acceptable for some women, but may not be recommended for women with breast cancer. Intrauterine devices like the Mirena IUS and the copper IUD can be considered.
What happens if I get pregnant while receiving chemotherapy?
Although this is extremely rare, an unplanned pregnancy while receiving chemotherapy could result in a complicated pregnancy. The treatment could also cause negative effects on your baby's development. A safe method of birth control must always be used while receiving chemotherapy.
If you think you might be pregnant, it is important to tell your physician right away so that steps can be taken to ensure the health of you and your baby.
After I've completed chemotherapy, how long must I wait before trying to get pregnant?
Pregnancies after chemotherapy are not uncommon, but need to be planned after the completion of your treatment. Consult your oncology physician to discuss your plans to get pregnant once your treatment is over. In many cases, pregnancy will not influence the return of cancer. There are situations in which pregnancy should be considered with caution. Many young women treated for breast cancer may become pregnant after chemotherapy and pregnancy is not prohibited in breast cancer survivors.
Are there risks of chromosomal abnormalities or cancer in children conceived after chemotherapy?
No. There is no known risk of chromosomal abnormalities in a woman's child after she has had chemotherapy. There is also no evidence that cancer treatment causes cancer in children conceived after the treatment is complete.
The symptoms of menopause
The most common symptoms of menopause are:
- Hot flashes
- Emotional changes
- Changes in the vagina
- Sexuality changes
- Weight gain
What are hot flashes?
Hot flashes are the most frequent symptoms of menopause. A hot flash is a momentary sensation of heat that may be accompanied by a red, flushed face and sweating. The cause of hot flashes is not known, but may be related to vascular instability. Studies show that hot flashes vary among women.
How long will I have hot flashes?
The severity and duration of hot flashes varies among women. Some women have hot flashes for a very short time during menopause. Other women may have hot flashes, at least to some degree, for life. Generally, hot flashes are less severe as time passes.
How can hot flashes be managed?
The best way to manage hot flashes is through hormone replacement therapy. There is much debate over whether estrogen should be prescribed when a woman is being treated for breast or endometrial cancer. It is best to ask your physician if hormone replacement therapy is the right treatment for you.
Other treatments that may relieve the symptom of hot flashes include:
- Vitamin B complex
- Vitamin E
- Ibuprofen
- Bellergal
- Clonidine
It is important to talk to your physician before you take any medications.
What are emotional changes?
Menopause may be associated with such symptoms as:
- Depression (may occur if poor sleep)
- Insomnia related to hot flashes
- Headaches (migraines usually get better after menopause)
- Anxiety
- Difficulty concentrating
- Irritability
- Energy loss
- Mood changes
Emotional changes are more difficult to associate with menopause because they commonly occur in other situations. In addition, cancer and its treatment can contribute to emotional changes.
Other possible causes of emotional changes include your work or home environment, life events, aging, psychiatric disorders (anxiety and depression) and some medications. These other possible causes make it difficult to attribute emotional changes exclusively to low hormone levels as a result of menopause.
How can emotional changes be managed?
Management of menopausal emotional changes is difficult since there may be many different influencing factors.
Emotional changes can be managed by:
- Supportive therapy
- Regular exercise
- Regular sleep
- Good nutrition
Hormone (estrogen) therapy may help some of these symptoms in some women and sometimes antidepressant medication is used. Ask your physician if hormone therapy is the right treatment for you.
Sometimes, just knowing emotional changes are normal may make them easier to cope with. Other ways to manage emotional changes include support groups and counseling. Occasionally, medications such as antidepressants, may be recommended.
What are some vaginal changes I might experience during menopause?
Low estrogen levels during menopause can cause vaginal dryness, which may result in painful sexual intercourse and/or decreased sex drive.
Sometimes menopause can cause thinning of the vaginal lining, resulting in vaginal "shrinkage." This is usually a late effect of menopause, but it can happen at any time. Ask your physician if estrogen cream or a vaginal dilator is the appropriate treatment for you.
What can I do to treat vaginal dryness?
Vaginal dryness can be treated with water-soluble lubricants such as Astroglide or K-Y Jelly. Do not use non-water soluble lubricants such as Vaseline shoud not be used because they can weaken latex (the material used to make condoms) and can cause infection. Non-water soluble lubricants can also provide a medium for bacterial growth, particularly in a person whose immune system has been weakened by chemotherapy. It is OK to use either olive oil or vitamin E oil as a lubricant and vaginal moisturizer. Do not douche. You can use over the counter rePhresh vaginal gel to lower the pH of the vagina to reduce odor and irritation.
What can I do to treat decreased sex drive?
Menopause should not necessarily affect a woman's ability to enjoy sex. Some studies suggest that decreased sex drive (libido) is most often related to painful intercourse caused by vaginal atrophy/thinness and dryness. Therefore, treating vaginal atrophy may be helpful.
It is important to note that active cancer therapy or the diagnosis of cancer can also affect your sex drive.
Treating a decreased sex drive may be accomplished with hormone replacement therapy and/or with the help of a counselor. Ask your physician if hormone replacement therapy is the right treatment for you.
Other changes associated with menopause
Other changes that may be associated with menopause can include:
- An increase in facial hair growth
- Osteoporosis
- Heart disease
What can be done about increased facial hair?
If facial hair growth becomes a problem for you, waxing or other hair removers (called depilatories) may be options. Be sure to consult with your physician and beautician to make sure the hair remover you choose will not harm your skin.
What is osteoporosis?
Osteoporosis is a decrease in bone mass resulting in thinner, more porous bone. Osteoporosis can lead to a higher risk of fractures or broken bones. Although osteoporosis is not a symptom of menopause, low estrogen levels during menopause have been associated with a reduction in bone mass. Not all women will experience osteoporosis - it is a condition that is also related to aging and heredity.
What can be done to prevent or manage osteoporosis?
Nutrition (especially calcium intake), increased physical activity and hormones (estrogen) are three factors that improve bone health. It is important to limit caffeine, tobacco, alcohol and carbonated beverages since these substances may reduce bone mass.
Hormone (estrogen) replacement therapy increases bone mass but must be prescribed by your physician. Other drugs you can ask your physician about include bisphosphonates including the infusion of zoledronic acid (Reclast) or subcutaneous denosumaub (Prolia) as well as nasal spray calcitonin, oral daily raloxifene (Evista) and a variety of oral bisphosphonates (alendronate/Fosamax, risedronate/Actonel or Atelvia, ibandronate/Boniva) See the Osteoporosis treatment guide on line.
How is heart disease associated with menopause?
Heart disease becomes more of a risk for women after menopause. Diabetes is a potent risk factor for heart disease in women. What can you do to help reduce your risk of heart disease?
- Regular exercise including daily walking
- Not smoking
- Eat fish or omega 3 rich foods twice a week
- Avoid weight gain
- Avoid any transfats in your diet
- Use olive oil
- Eat a colorful diet with fruits, vegetables, whole grains and fish
If your cholesterol is high, a low-cholesterol diet Mediterrean diet will help reduce your risk of heart disease. In some cases medication may be required. If you have a personal or family history of heart disease or any diabetes you should inform your physician.