Early Menopause

Cancer treatments may cause young women to experience early menopausal symptoms.  Women generally go through menopause around 40 or 50 years of age.  However, some cancer treatments may cause menopause symptoms before the usual time.  During menopause a woman's body stops producing hormones, such as estrogen, progesterone, and testosterone.  Ovaries also stop producing eggs. Menstrual cycles become irregular and eventually stop.  Menopause symptoms induced through breast cancer treatment are usually more severe than natural menopause.  Some of the common symptoms are:

• Hot flashes
• Vaginal dryness
• Decreased sex drive
• Sleep disturbances
• Mood swings
• Loss of memory

 

Causes of Early Menopause

Estrogen loss is the primary cause of menopause symptoms.  Treatment effects on ovaries are a significant factor in early menopause because ovaries are used for estrogen production in a woman's body.  Surgical removal of ovaries, damage to the ovaries through chemotherapy or radiation therapy, or hormone therapy may stop estrogen production.  Most pre-menopausal women experience early menopausal symptoms during cancer treatment.

Cancer treatment may also cause irregular menstrual cycles.  In some cases, menstrual cycles will stop completely.  The younger women are the more likely their menstrual cycles will return to normal after treatment is completed.  However, women older than 40 to 45 years old are not likely to regain normal menstrual function.

 

Hot Flashes

Hot flashes are one of the most common symptoms of menopause.  They are also the symptom that women find the most uncomfortable and inconvenient.  During an episode women will feel a sudden and intense hot feeling on the face and sometimes in the upper body.  Simultaneously women may have a rapid heartbeat, nausea, dizziness, headache, weakness, and/or sweating.

Each woman may experience hot flashes in different ways.  Duration and frequency varies according to each individual case.  Some episodes last a few minutes, often as night sweats.  In general, hot flashes may last for a year or two after menstrual cycles halt.  Variations may also depend on the type of treatment received.  Hot flashes caused by tamoxifen usually improve after 3-6 months after treatment.

Specific triggers often cause hot flashes.  Although triggers are different for each woman, the most common are alcohol, caffeine, spicy food, hot weather, stress, hot showers, and saunas.  Once a woman has identified her specific triggers, she should avoid them to decrease frequency of hot flashes.

 

There are some proactive ways women can use to cope with hot flashes.  Some of these are:

• Keep ice water nearby to drink upon beginning of hot flashes.
• Dress in layers.  Removal of clothing layers upon onset of a hot flash may provide relief.
• Wear cotton while avoiding wool and synthetic materials.
• Cotton sheets on the bed.
• Cool shower before going to sleep.
• Stand in front of open refrigerator door at onset of hot flash.

Some vitamin supplements may help reduce hot flashes.  Vitamin E or vitamin B supplements have been shown to be helpful.  In some severe cases, a physician may prescribe a low dose of an antidepressant, such as venlafaxin (Effexor) or paroxetine (Paxil).  Mild sedatives may also be used, however one should be aware of risks associated with them.

Herbal remedies are also another option to relieve hot flashes.  Many women use herbs such as ginseng, black cohosh, licorice root, or evening primrose oil.  Women should consult their physician before using herbal remedies.  Safety of such remedies has not been determined.

 

Vaginal Dryness

With lack of estrogen, vaginal membranes stop producing lubricating fluids and become thin and less flexible.  Irritation, itchiness, and painful sexual intercourse maybe experienced.  A lubricant can help ease vaginal dryness, which may cause painful intercourse.  Some lubricants are available over-the-counter.  Women should avoid oil-based lubricants or those with scents, alcohol or other additives.  Water-based lubricants are preferred.  Vaginal moisturizers, such as Replens, may also help.  Physicians can also prescribe a low-dose vaginal estrogen cream.

 

Managing Menopause

Women experiencing natural menopause may be prescribed hormone replacement therapy.  However, for breast cancer survivors and patients, this therapy is not safe.  Estrogen therapy may also decrease the effectiveness of some chemotherapy drugs.

Lifestyle changes can relieve some symptoms.  Exercise, especially aerobic exercise may help greatly.  Aerobic exercise for 20-30 minutes per day at least three times per week is suggested.  Low fat foods and healthy eating at short intervals may ease mood swings by helping maintain blood sugar levels.  Holistic methods such as meditation, visualization, massage, and yoga can help alleviate symptoms.  Despite everything that women can do, some symptoms require medications as well as lifestyle changes.  Women should talk to their doctor about associated risks of some medications.  Estrogen loss can increase risk of heart disease and osteoporosis (bone loss).  This is due to the protective effects estrogen has on the bones and heart.  Women should consult their doctor about what can be done to protect against heart disease and osteoporosis.