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Gynecologic cancer treatments often cause a number of side effects—including symptoms of menopause. In fact, research suggests that 30 to 40 percent of all women with a gynecologic cancer experience menopause earlier than they would have without the disease. Susan A. Peck, MSN APN, Nurse Practitioner in the Gynecologic Oncology Department of SMG provides expert insights via the following Q&A about navigating the menopause journey after cancer.
Q: What is the connection between Gynecologic cancers and menopause?
A: While many women who are diagnosed with a gynecologic malignancy are already in menopause, treatment for such a cancer in a younger woman, whether it be surgical or chemotherapy, may start menopause prematurely. Ovarian function and the production of estrogen may decline or stop entirely from chemotherapy and/or the removal of a woman’s ovaries, called an oophorectomy.
Q: What are the most common symptoms of menopause?
A: Symptoms of menopause are related to the body’s loss of estrogen. The most common symptom of menopause is hot flushing, the feeling of rising heat in the body accompanied by sweating. For many women, this is a nuisance and manageable, however for some women hot flushing can be very aggressive and interfere with quality of life. Another common symptom of menopause is vaginal dryness. As estrogen levels decline, the vagina may become thin and dry. This may cause intimacy to be uncomfortable but can also cause irritation and itching in women who are not sexually active.
Q: What are the treatment options?
A: If symptoms are bothersome, there are treatments that can help. For example, acupuncture can improve hot flushing, as can antidepressants (SSRIs). Hormone therapy gives the body estrogen lost in menopause, but in many cases, especially in cancer survivors, it may not be a safe option. There are many vaginal moisturizers and lubricants that are available over-the-counter to improve vaginal dryness. Vaginal estrogen is also an option but may have similar risks related to oral hormone therapy.
Q: What do I need to know about hormone therapy?
A: Hormone therapy replaces the estrogen (and sometimes progesterone) hormones the body loses in menopause, whether it be a natural menopause, from chemotherapy or surgery. The only FDA approved indications for the use of hormone therapy are to treat moderate to severe hot flushes and to prevent osteoporosis. However, remember that many cancers are stimulated to grow by hormones and so often hormone therapy is not a safe or appropriate option for cancer survivors. It’s important to discuss the matter with your health care provider.
Q: How can I manage menopausal symptoms?
A: For most women, menopausal symptoms are tolerable. But if menopause is brought on quickly by surgery or chemotherapy, the symptoms may be more severe. Menopause, hormone changes and cancer treatment may change the way our bodies look (our body shape may change and weight gain may occur). Depression and mood changes may occur. Your libido may also be different (however many women still enjoy intimacy in menopause). It is important to tell your health care provider if you feel down or depressed or are struggling with any of these issues. There are many support groups you can join. Also remember to prioritize self-care such as rest, exercise, and staying active in a supportive community.
Remember that cancer cannot conquer the spirit, erode confidence or invade the soul. You can not only survive but thrive in the journey after cancer.