Menopause

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Women usually enter the menopause naturally in their late 40's early 50's. Many treatments for breast cancer however, can suppress the production of female hormones by either blocking the oestrogen function or  interfering with its production from the ovaries causing the menopause or menopausal symptoms prematurely. During the menopause the blood levels of the the female hormone oestrogen start to drop and the hormone secreted from the pituitary gland in the head increase (LH, FSH). This produces the typical menopausal signs and symptoms  

In pre-menopausal women with breast cancer menopause may be deliberately recommended as a therapeutic manoeuvre either using a drug called Zoladex or removing the ovaries surgically or now less often irradiating them. The risk and benefits of this should have been discussed before the start of therapy. Otherwise, the production of oestrogen may be damaged as a side effect of chemotherapy, radiotherapy or hormone therapy. These treatments, particularly chemotherapy may make your menstrual cycle irregular and your period may stop and in some women this may be permanent. If your periods stop you could still become pregnant and you should take contraceptive precautions during chemotherapy. However, the contraceptive pill may not be suitable at this time so you should consider using barrier methods such as the sheath and diaphragm. Your doctor can advise you. 

What is menopause? The menopause describes events taking place in a woman which brings about the end of her childbearing days. During the menopause the blood levels of the the female hormone oestrogen start to drop and the hormone secreted from the pituitary gland in the head increase (Lutinising hormone and follicle stimulating hormone). By the end of the menopause a woman will:

• no longer produces eggs
• have reduced production of sex hormones, importantly oestrogen
• stop menstruating

What are the typical signs and symptoms? The symptoms experienced by women vary considerably. Some of the more common symptoms to be expected are: 

Change of periods - initially become lighter or heavier, shorter or longer, more erratic, then eventually stopping.

Hot flushes and night sweats - A lack of oestrogen can cause irregularities in the body's cooling system. Hot flushes: a sudden unpleasant sensation of burning heat spreading across the face, neck and chest, can occur. Some women experience one or two flushes a week, whilst others can have ten or more a day but generally, the number of hot flushes will decrease over time.during a hot flush your heart will beat faster and your skin will feel warmer and sweaty. Hot flushes and night sweats will cease once your hormones have settled down - see coping with hot flushes.

Vaginal discomfort - your vagina will shrink slightly and the lining will becomes drier, thinner, less resilient and more prone to infection; spotting may even occur after intercourse. You may find that a lubricant such as KY jelly helps. Any vaginal infection should be dealt with by your doctor - coping with vaginal dryness

Urinary problems - your urinary passages may also become more prone to infection drink plenty of water

Reduced bone strength -  the calcium and protein in the bones may reduce after the menopause. This means your bones may become brittle, making it easier to break your bones. this can be monitored with a bone density scan (DEXA Scan) and there are now several treatments available to help osteopenia (mild loss) and osteoporosis (Marked bone loss). There are several lifestyle factors which reduce the risk of bone loss with exercise being the most important. - look after your bones

Mood swings and irritability. You  may notice that you are less tolerant, more anxious or that you are having mood swings. It will help to have a regular sleep pattern and to pace yourself through the day. The odd treat for yourself, time out and learning how to relax will help you cope better and boost your morale. There are ways to aid relaxation, such as relaxation tapes, and the nursing staff can advise you on how to acquire these. You may find that resting during the day (if you are able) will make up for some of the sleep lost at night.
Talking about your feelings can be helpful. Many patients find it worthwhile to attend a support group to spend time with other women who are going through a similar experience.
It is important to remember that it is entirely natural to experience strong feelings as a result of a diagnosis of breast cancer, and in reaction to some of the less acceptable treatment side effects.
If you find that you are unable to cope with mood swings or if you are feeling "down" for  prolonged periods, try talking to your GP, who may be able to refer to a professional counselor or therapist who can help.

Weight gain - This can be a distressing result of lowered oestrogen levels. A well balanced, low fat diet can help to reduce weight and the nursing or medical staff can advise you.  You may gave had a lot to cope with and your general fitness is the most important thing. Although this is not as a direct result of the menopause, it often coincides with it. It is important to take regular exercise to prevent heart attacks and high blood pressure. - Tips to help reduce weight gain

Reduction in sex drive In some cases testosterone (the hormone responsible for controlling the sex drive) can be effective in restoring libido. Testosterone is given every six months as an implant under the skin of your buttock or abdomen. Reduction in sex drive, may result from low oestrogen levels, because you are stressed, or because of any of the symptoms described in this leaflet. If this causes problems in your relationship it may help to talk about it with the nurse or your oncology doctor. Using lubricants for vaginal dryness or by altering lovemaking positions can help. Some useful over the counter products are available.  - coping tips

Headaches These can simply be due to anxiety or lack of sleep but please report frequent headaches to  the medical staff. Taking your usual pain killers can help.

Skin and breast changes: Your skin and breasts may become less supple and less firm

Other issues Contact your doctor if you experience any of the following symptoms

1. Any lumps you find in your breasts.
2. Any discharge or bleeding from a nipple, or any tendency for it to turn inwards.
3. Any unexpected bleeding from the vagina, even if it is slight.
4. Any vaginal discharge.
5. Any persistent pain in your abdomen.

Help with menopausal symptoms:-

• Lifestyle tips and hot flushes
• Diet and hot flushes
• Hormone replacement therapy
• Other medication for hot flushes
• Help with vaginal dryness
• Clothing to help hot flushes
• Self help lifestyle books

Hormone replacement therapy (HRT)

HRT replaces hormones that you body is unable to make itself and will help stop the symptoms of menopause, especially hot flushes, night sweats and possibly emotion swings. If you don't have a history of breast cancer, the risks involved in taking HRT are minimal and is used by millions of women around the world. HRT can be administered in several ways:

• As a tablet taken every day
• As a cream applied to the skin or vagina
• As a tiny implant under the skin of the abdomen
• As a patch applied to the skin, twice weekly.

If you have an intact womb, oestrogen must be given with a progesterone several days each month to simulate the normal monthly cycle. This causes the return of monthly ‘periods’ although these are usually much lighter than they were but this does not mean that you are fertile once again, but you should remember that the low doses used in HRT are not enough to guarantee contraceptive cover. You must take other precautions until you are quite sure you will not have a final, late fertile cycle.

HRT and cancer
There is a slight increased risk breast cancer from HRT especially if used for long periods of time. HRT should not be used by those who have had breast or uterine cancer.

HRT and blood pressure?
Blood pressure is not usually affected by HRT

Other side effects
These can include:

• headaches and a feeling of sickness during the first weeks of treatment
• tender breasts
• leg cramps

These symptoms usually disappear after the first few weeks of treatment. Consult your doctor if you are concerned about them.

In general, regular exercise and a healthy life style will make menopausal symptoms easier to deal with. The symptoms should improve over time and you will learn to manage them.

If any of the above symptoms make you feel low, anxious or depressed please remember that your oncology specialist and the nursing staff are there to help and there are often things we can do to make your symptoms easier to live with.

For how long will I need HRT?
This mainly depends on what symptoms are being treated. Women who are likely to suffer severe bone loss may benefit from taking HRT for many years. Other symptoms may only need to be treated for up to two years.