Changes To Skin And Hair
The menopause causes changes in the production of collagen, a protein found in the skin. Oestrogen is important for collagen production. It helps to keep the skin moist and elastic .
Low levels of oestrogen lead to the skin becoming drier, thinner and less elastic.
Lack of oestrogen can also be linked with hair becoming thinner and dry.
These changes can affect how you feel about yourself. Trying the following may help:
- Eat a healthy diet
- Avoid very hot showers or baths
- Avoid scented soap
- Apply body lotion to help keep the skin moist
- Use a light hair conditioner regularly on your hair
- Use a dry shampoo to absorb moisture without drying out your hair
- Use a heat-protection spray when using heated appliances
Induced Premature Menopause Or Early Menopause
Induced menopause may result from premenopausal bilateral oophorectomy or from cancer treatments including chemotherapy and radiation. Premature menopause from these causes has increased over time because of the improved success in the treatment of cancer in children, adolescents, and reproductive-age women. Similarly, the practice of prophylactic bilateral oophorectomy at the time of hysterectomy has increased over time . However, evidence for the long-term risks and adverse health outcomes following induced menopause is starting to accumulate.
Can Treatment For Menopause Increase My Cancer Risk
One of the biggest questions around menopause is the use of menopausal hormone therapy , also called hormone replacement therapy, for managing the symptoms of menopause and how it impacts a persons risk for cancer. Because the symptoms of menopause are mostly due to low levels of estrogen in the body, MHT is sometimes used to treat these menopausal symptoms. MHT can consist of either estrogen alone or combined estrogen-progestin therapy .
The use of MHT declined significantly after the initial publication of the Womens Health Initiative study in 2002, which showed that people taking EPT had a higher risk of breast cancer, heart disease, stroke, and blood clots. Although further analysis showed that some of the risks were over-estimated and there were found to be some benefits of MHT, MHT is currently prescribed to only about 3% to 4% of perimenopausal and postmenopausal people.
MHT can also increase the risk of developing a gynecologic cancer. This risk varies based on the type of MHT used. Because estrogen-alone MHT increases the risk of uterine cancer, for example, it cannot be given to people who still have a uterus. For these people, combined estrogen-progestin therapy is recommended, which eliminates that increased risk of uterine cancer. The risk of ovarian cancer is very slightly increased with either estrogen alone or combined estrogen-progestin MHT. MHT does not increase the risk of cervical cancer.
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How Does Menopause Affect Cancer Risk
Our expert answers some common questions about the link betweenmenopause and a woman’s cancer risk.
Menopause often brings more than physical changes. It also may bring uncertainty about cancer risks and cancer prevention.
We spoke with Therese Bevers, M.D., medical director of MD Andersons Cancer Prevention Center, about menopause and cancer.
How does menopause affect a womans cancer risk?
Menopause does not cause cancer. But your risk of developing cancer increases as you age. So women going through menopause have a greater chance of developing cancer because theyre older.
How does the age at which a woman starts menopause affect her cancer risk?
Starting menopause after age 55 increases a womans risk of breast cancer and endometrial cancer. Thats probably because shes been exposed to more estrogen. During a womans menstrual cycle, estrogen stimulates the uterus and breast tissue. So the more menstrual periods a woman has, the longer these tissues are exposed to estrogen.
Women who start menopause later also may have an increased risk of ovarian cancer, possibly because they have had more ovulations.
Some women receive hormone therapy to cope with menopause symptoms. How safe is HT?
Some studies also suggest that using HT after menopause may slightly increase ovarian cancer risk. Generally, the longer you use hormone therapy, the more your cancer risk appears to increase.
What are some safer HRT alternatives that you recommend?
Treatments: Hormone Replacement Therapy
Did you know? HRT works by replacing the hormones your body stops making after the menopause
There are a range of treatments available to help manage your menopause symptoms, and in many cases, vastly improve your quality of life.
Your first step should be talking to a health professional about the options available to you, so you can make an informed decision about the potential benefits and risks. Dont wait until symptoms become unmanageable before you seek advice.
What is HRT and how does it work?
HRT is a treatment that relieves symptoms by replacing the estrogen your body stops making after the menopause. The type of estrogen most commonly used these days is 17 beta-estradiol.
Available as a skin patch, gel applied to the skin or as a tablet, HRT remains the most effective treatment to relieve symptoms. Hot flushes and night sweats usually stop within a few weeks of starting HRT. Many of the vaginal and urinary symptoms usually resolve within three months, but it can take up to a year in some cases.
You should also find that symptoms such as mood changes, difficulty concentrating, aches and pains in your joints and the appearance of your skin will also improve.
HRT will also help protect against osteoporosis and cardiovascular disease, which is especially important in women who go through an early menopause.
Is HRT suitable for me?
Testosterone
Did you know? Women produce three times as much testosterone than estrogen before the menopause
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Treatments That Can Cause Early Menopause
Cancer treatments that can cause early menopause include:
- Surgery. Having both ovaries removed causes menopause to happen right away. If you are age 50 or younger, your provider may try to leave an ovary or part of an ovary if possible. This can keep you from having early menopause.
- Chemotherapy . Some types of chemo can damage your ovaries and cause early menopause. You may have menopause right away or months after treatment. Your risk of early menopause from chemo depends on the type and amount of chemo drug you have. The younger you are, the less likely you will have early menopause from chemo.
- Radiation. Getting radiation in your pelvic area can also damage your ovaries. In some cases, your ovaries may heal and start working again. But, if you get large doses of radiation, the damage may be permanent.
- Hormone therapy. These treatments used to treat breast and uterine cancers can often cause early menopause.
Ask your provider if your cancer treatment may cause early menopause.
Not Being Physically Active
Evidence is growing that regular physical activity reduces breast cancer risk, especially in women past menopause. The main question is how much activity is needed. Some studies have found that even as little as a couple of hours a week might be helpful, although more seems to be better.
Exactly how physical activity might reduce breast cancer risk isnt clear, but it may be due to its effects on body weight, inflammation, and hormone levels.
The American Cancer Society recommends that adults get 150 to 300 minutes of moderate intensity or 75 to 150 minutes of vigorous intensity activity each week . Getting to or going over the upper limit of 300 minutes is ideal.
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Spontaneous Premature Ovarian Failure Or Early Menopause
Premature ovarian failure , also now referred to as primary ovarian insufficiency or primary ovarian dysfunction , is a syndrome of amenorrhea, low sex steroid levels, and elevated gonadotropin levels among women younger than age 40 years. POF is most frequently idiopathic but may also be due to autoimmune disorders, genetic causes, infections or inflammatory conditions, enzyme deficiencies, or metabolic syndromes . POF is reported to affect approximately 1% of women under age 40 years and spontaneous early menopause is reported to affect approximately 5% of women between ages 40 and 45 years .
POF has been found to be associated with intermittent ovarian function in nearly half of the women affected . While spontaneous or induced return of ovarian function is possible, most women with POF experience sustained sex steroid deficiency for longer periods compared with women who experienced spontaneous menopause around the median age. Thus, POF and other causes of premature spontaneous menopause are generally classified together when evaluating long-term health outcomes.
Coping With Breast Cancer Treatment And Early Menopause
Bahar explains how chemotherapy for breast cancer brought on menopause.
ACOG does not endorse companies or products.
As the daughter of a breast cancer survivor, Bahar has always been careful to schedule mammograms and pay attention to how her breasts look and feel. Three years ago, at age 50, she found a lump in one of her breasts. She had a type of breast cancer that responds to the hormone estrogen, just as her mother had.
Estrogen-blocking medications are the usual chemotherapy for this type of cancer. But blocking estrogens activity can cause symptoms of menopause. In this edited interview, Bahar describes her journey through cancer treatment and menopause.
ACOG: How did you learn you had cancer, and what was the treatment?
Bahar: After I found the lump, I called my doctor. They sent me for a mammogram and said it looked normal. I still wanted them to do a biopsy.
I had tenderness in my armpit, so they biopsied that area too. It turned out the cancer had spread to my lymph nodes. My health care team did a lumpectomy and took out 27 lymph nodes, five of which were affected.
ACOG: When did you first think you might be in menopause?
Bahar: I had surgery in December, and a period immediately afterward. In January, I had my first chemotherapy, and I did not have any periods at all after that. They stopped completely.
ACOG: Did you have any menopausal symptoms before you learned you had breast cancer?
ACOG: When was it confirmed that you had gone through menopause?
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How Is Breast Cancer Detected And Diagnosed
Detection of breast cancer in its early stages — hopefully before it moves outside the breast — can significantly improve the chances that treatment will be successful.
The survival rate from breast cancer increases when the disease is detected and treated early.
Many breast cancer experts, including the American Cancer Society, recommend beginning routine screening for breast cancer with a mammogram at age 45. Others suggest waiting till age 50. Your doctor may recommend starting earlier than age 45, depending on your individual risk factors.
The purpose of a mammogram is to find abnormalities that are too small to be seen or felt. However, mammograms will not detect all breast cancers, which is why physical breast exams are very important.
The American College of Obstetricians and Gynecologists recommends that women in their 20s and 30s have a health care provider perform a breast exam every one to three years and then every year once they turn 40.
The ACS states that research has not shown a clear benefit of performing regular breast self-exams. Women who choose to perform breast self-exams should have their technique reviewed during an exam by a healthcare provider. Any change in their breasts noted on breast self-exams should be reported promptly to a doctor.
To find out if you are at increased risk for breast cancer, consult your doctor.
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Will My Menopause Be Temporary Or Permanent
Did you know? Menopause due to treatment for cancer can be temporary or permanent, depending on your age and type of treatment
This is dependent on a number of factors, including your age and the type of cancer treatment you are having.
If you have an oophorectomy or a hysterectomy where both ovaries are removed, then you will have your menopause immediately, regardless of your age. If one of your ovaries is left intact after an oophorectomy , theres a chance that youll experience the menopause within five years of having surgery.
The menopause after pelvic radiotherapy or chemotherapy could be temporary or permanent. This usually depends on how close you are to the age of your natural menopause, and the dose of radiation or type of drugs used.
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Protecting Your Bones And Heart
Since early menopause can affect your bone and heart health, it’s important to take steps to keep them healthy. Here is how:
- Eat healthy foods. Focus on fresh fruits and vegetables, whole grains, lean meats, fish, nuts, beans, and low-fat dairy products.
- Get enough calcium and vitamin D. These nutrients help build bones. Foods rich in calcium include fat-free yogurt and milk, spinach, and white beans. Your body makes most of its vitamin D from the sun, but you can also get it from salmon, eggs, and milk that has vitamin D added. Ask your provider if you need to take supplements.
- Get exercise. The best kinds of exercise for your bones are weight-bearing exercises that work your body against gravity. Some ideas include walking, yoga, hiking, dancing, lifting weights, gardening, and tennis.
- DO NOT smoke. Smoking raises your risk for both osteoporosis and heart disease. If you need help quitting, ask your provider.
- Ask about a bone density test. This is a test that checks for osteoporosis. This is a recommended test for all women at age 65, but you may need one earlier if you have early menopause.
- Keep track of your numbers. Make sure your provider checks your blood pressure, cholesterol, and blood sugar levels regularly. These simple tests can help tell you if you are at risk for heart disease or stroke.
The Question Of Hormone Replacement Therapy
Sahni, who is also a specialist in the management of perimenopausal and menopausal disorders, said that hormone replacement therapy is a safe and effective treatment for many women. Symptoms including insomnia, osteoporosis and irregular periods may get better with HRT, and women should discuss options with their healthcare provider.
However, for women with a history of breast cancer, the use of systemic hormone therapy is generally not advised, but that does not mean you have to sweat in silence.
“Things like vaginal estrogen specifically for vaginal and urinary symptoms actually can be considered in conjunction with a woman’s medical oncologist,” Sahni explained. “Try the nonhormonal options first, and if that’s not enough, know that we have a lot of different options to help.”
For those of us still soaking our sheets at night, Sahni said new nonhormonal agents are on the way. “There is one in the pipeline undergoing clinical trials. My hope is that we have another exciting option to help treat menopausal symptoms in women with a history of breast cancer,” Sahni said.
Menopause is hard enough, and although there is no surefire way to prevent breast cancer, women can help reduce the risk by quitting smoking, limiting alcohol and maintaining a healthy lifestyle.
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Can I Still Get Pregnant
Even if you stop having periods and experience menopausal symptoms, you may still be fertile and could become pregnant. You may also still be fertile even if you are going through the menopause, as your ovaries might not have stopped working completely.
If you are unsure about your fertility or menopausal status, talk to your treatment team or GP, who can discuss contraception where appropriate.
Sometimes your treatment team may suggest having a series of blood tests to check if you are pre or postmenopausal, but this isnt appropriate or accurate for everyone and will depend on where you are in your treatment.
For some women, having an early menopause may mean coming to terms with the possibility of being infertile. This can be very difficult to cope with, especially if youre considering starting a family or having more children.
Find out more about breast cancer and fertility.
Effects Of Early Menopause
Early menopause due to cancer treatment can be a shock. It can feel physically and emotionally overwhelming. It can cause difficult symptoms as well as affect your sex life and sexuality.
A sudden menopause can cause more severe symptoms than a natural menopause. The symptoms can last a number of years and they can change with time.
Menopausal symptoms
- urinary problems such as needing to wee urgently, infection or incontinence
Fertility
Your fertility might also be affected and you may no longer be able to have children naturally. This loss of fertility can be upsetting even if you have a family or did not intend to have children.
Whether this happens to you depends on different factors. For example, your age and the cancer treatment you have had. Speak to your doctor if this is a concern for you. They can explain how likely this is in your situation.
Some women who have experienced an early menopause can still get pregnant. So you may still need to use contraception.
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How Menopause Impacts Breast Cancer Treatment
For many years, anyone with breast cancer that had spread to the lymph nodes automatically got chemotherapy. This treatment stops or slows the growth of rapidly-dividing cancer cells, yet itâs not without downsides. In addition to well-known side effects like nausea and hair loss, it may also cause nerve damage, lead to cognitive issues, and raise the risk infections — among other problems.
Yet chemo was our hammer, and when you have a hammer, everything is a nail. For a while it was the best — and only — means we had to fight against cancer that appeared to be spreading. But using it so often meant that many people were being overtreated and getting all of the downsides without many, if any, benefits. A landmark 2018 study revealed that up to 70% of women with breast cancer could safely forgo chemo.
Nowadays, when a woman is diagnosed with breast cancer, we discuss not only the size of the tumor and the stage of the cancer but also the tumorâs characteristics: Whatâs driving it, and how aggressive is it? That helps us figure out how aggressive to be when treating it. We also have to factor in a womanâs age and, perhaps more importantly, whether or not she has gone through menopause.