Menopause occurs when a woman’s body stops producing hormones (estrogen, progesterone, and testosterone), the ovaries stop producing eggs, and menstrual cycles become irregular and subsequently stop. Menopause usually occurs in women in their mid-40s to mid-50s. Early menopause is the term used for menopause that occurs earlier than this time. There are many symptoms associated with menopause; not all women will have every symptom or experience the same intensity of symptoms. Among the most common menopausal symptoms are:
- Hot flashes
- Vaginal dryness
- Loss of libido (sex drive)
- Mood swings
- Sleep disturbances
- Memory problems
Menopausal symptoms caused by breast cancer treatments are usually more severe than those that occur during natural menopause because the hormonal changes are abrupt rather than gradual.
Causes of early menopause
Early menopause occurs in nearly half of premenopausal women treated for breast cancer and is caused primarily by a loss of estrogen. The level of estrogen in the body may be reduced as a result of surgical removal of the ovaries (where estrogen is produced), damage to the ovaries by chemotherapy or radiation therapy, or hormone therapy (given to stop the production of estrogen).
During breast cancer treatment, menstrual cycles may become irregular and may stop altogether. This irregularity may be permanent or temporary, depending primarily on age. Women who are younger than 35 to 40 years when they receive chemotherapy are likely to regain normal menstrual function after treatment has been completed; women older than 40 to 45 years are not.
Types of menopausal symptoms and their management
Over the past decades, physicians have used hormone replacement therapy as the primary approach to managing menopausal symptoms. However, such therapy is not considered safe for women who have had breast cancer. In addition, estrogen therapy may decrease the effectiveness of tamoxifen or aromatase inhibitors.
Simple lifestyle changes can help to ease the discomfort of many menopausal symptoms. Regular exercise, especially aerobic exercise (walking, running, swimming, bike riding), can help reduce hot flashes, mood swings, and sleep disturbances and increase self-image and libido. You can derive maximum benefit by engaging in aerobic exercise for at least 20 to 30 minutes per day at least three times a week. A low-fat diet may help alleviate hot flashes in some women, and healthy eating at short intervals can help maintain constant blood sugar levels in your body, which can ease mood swings. Relaxation techniques, such as deep-breathing exercises, meditation, visualization, massage, and yoga, can help reduce stress, which may also help decrease menopausal symptoms.
Sometimes, lifestyle changes alone cannot eliminate menopausal symptoms, and medications may be needed if one or more symptoms are severe and interrupt your normal daily activities. There are risks associated with some of these medications and, as always, you should talk to your oncologist, gynecologist, and/or family doctor about the risks and benefits of treatment options for your individual situation.
Following are brief descriptions of the two most common menopausal symptoms associated with breast cancer treatment, as well as a note about the effects of menopause on long-term health. Other menopausal symptoms include sleep disturbances, sexuality issues, depression and memory problems.
A hot flash is a sudden, intense hot feeling on your face and sometimes upper body. A rapid heartbeat, nausea, dizziness, headache, weakness, and/or sweating may also occur at the same time. A “flush” follows the hot flash; during a flush, you become red and perspire. Hot flashes are perhaps the menopausal symptom that women find the most uncomfortable and inconvenient.
Among the general population of women, hot flashes may last for a year or two after menstrual periods have stopped or may persist for several years. The intensity of hot flashes caused by tamoxifen usually improves after the first three to six months of treatment. Hot flashes vary in duration and frequency; most episodes last a few minutes, and they often occur at night, with night sweats often waking up women in the middle of the night.
Hot flashes may have specific triggers. These triggers vary among women, but the most common ones include alcohol, caffeine, spicy food, stress, hot weather, hot showers and saunas. Identifying and avoiding triggers can help decrease the frequency of hot flashes.
Some suggestions for coping with hot flashes include the following.
- Wear cotton and avoid wool and synthetic materials.
- Dress in layers, so you can remove clothes in layers if needed.
- Keep ice water nearby to drink when a hot flash begins.
- Wear cotton pajamas or a nightgown and use cotton sheets on the bed.
- Take a cool shower before going to bed.
- Open the refrigerator door and put your head in when a hot flash begins.
Some studies have shown that vitamin E or vitamin B6 supplements can help reduce hot flashes. If hot flashes are severe, your doctor may suggest a low dose of an antidepressant. The drug that has been shown to be most effective is venlafaxine (Effexor); paroxetine (Paxil) is another alternative and may be better tolerated by some women. Mild sedatives may also be of benefit, but there are risks associated with their use.
Many menopausal women have turned to herbal remedies, such as ginseng, black cohosh, evening primrose oil, licorice root and others to alleviate hot flashes. However, the safety of these remedies in women with breast cancer has not been determined. Do not take any herbal supplements without talking to your doctor first.
Vaginal dryness is caused by the loss of estrogen; the membranes of the vagina become thin and less flexible and stop producing lubricating fluids. Vaginal dryness can cause discomfort, irritation, itchiness, and painful sexual intercourse.
A lubricant can help ease vaginal dryness and ease pain with intercourse. Several lubricants are available without a prescription. You should select a water-based lubricant and avoid oil-based lubricants (such as petroleum jelly) or lubricants with scents, alcohol or other additives. A vaginal moisturizer (such as Replens) may also be of benefit. If discomfort persists, your doctor may suggest a low-dose vaginal estrogen cream. Exposure to estrogen is low with this cream, as it is used in only small amounts and for a short period of time.
Estrogen has a protective effect on the bones and the heart (the protective effect on bone is better documented than it is for the heart). The decrease in estrogen in menopause increases the risk of heart disease and osteoporosis (bone loss). Talk to your doctors about ways to lower your risk of heart disease and to prevent osteoporosis. Click here to learn more about bone loss.