While menopause is a widely known and understood phenomenon, a less commonly discussed but no less difficult experience is that of medical menopause, a potential side effect of breast cancer treatment. Similar in many ways to conventional menopause, it involves the premature arrest of a person’s reproductive cycle, usually in response to chemotherapy,radiation, or overain supporession placing stress on the body and depleting it’s estrogen. There are a few different causes, which may or may not be permanent:
Chemotherapy or Radiation-driven: This type of medical menopause is very person-specific, and may occur in some while not in others. It is thought to be a protective mechanism undertaken by the body in order to keep cancer therapies from harming fertility. In some cases, menopause is transient, and fertility returns after treatments have ended. In other cases, however, menopause is permanent. This is usually the case for people who were already close to menopause, commonly for those age 40 and above. Treatments such as CMF therapy, composed of Cytoxan (cyclophosphomide), Trexall (methotrexate), and Adrucil (5-fluorouracil), or Soltamox (tamoxifen) all may put a patient at a greater risk for medical menopause.
Surgical menopause: In some instances, ovary removal (also known as a oophorectomy) or a hysterectomy (removal of the uterus) are advised for those at risk for breast cancer. There are a few types of hysterectomy, but the most common is a total hysterectomy, which removes the uterus and cervix but not the ovaries. The most common hysterectomy for cancer treatment is a radical hysterectomy, which removes the uterus, cervix, top portion of the vagina, and occasionally surrounding pelvic lymph nodes. In these cases, menopause is surgically and permanently induced as reproductive organs are removed, which may cause an increased number of side effects due to the sudden nature of the procedure.
Hormone therapy treatments: Compounds such as Zoladex (goserelin) and Lupron (leuprolide) are used as treatment for hormone receptor-positive breast cancers, and may shut down estrogen production in the uterus as a side effect. Normally, once a person stops taking these therapies, function will return. However, the length of menopause may vary from person to person.
Regardless of the cause, medical menopause, specifically in those with breast cancer, tends to be more symptomatic than conventional menopause. The most commonly reported side effects include hot flashes, body pain, vaginal dryness, mood changes, insomnia, weight gain, and headaches.
Medical menopause, especially when very premature, can result in significant mental and disruption to the person suffering from it. Even so, there are a few studied treatments to help ease the burden medical menopause may bring. Apart from hormone therapies, some antidepressants have been shown to improve hot flashes. Vaginal moisturizers are recommended to combat vaginal dryness, and calcium supplements and other bone density drugs such as zoledronic acid may be used to preserve bone density post-menopause. In terms of lifestyle changes, using natural sleep aids, talking to a mental health professional, or undergoing diet and exercise programs all may improve symptom management.
If you are facing medical menopause, it is recommended that you discuss your concerns with a medical professional, as they will be able to best recommend potential treatments or management strategies tailored to your experience. If you would like to share your story regarding medical menopause and breast cancer, we’d love to hear it! And for those looking for additional support, check out our support groups and other events- we would love to have you there, and we look forward to supporting you throughout your breast cancer journey.