When most younger women think of menopause, they think of their mothers having hot flashes at the dinner table or hearing about sleepless nights from their aunts but women dealing with cancer at many ages may experience these symptoms. Menopause can manifest in a variety of ways including hot flashes, mood swings, changes in sex drive, and memory loss. While the average age of menopause in the United States is 51, cancer treatments can induce premature menopause, either permanently or temporarily, in much younger women. Survivors of childhood cancer are also up to 13 times more likely to experience premature menopause than women without a cancer history.
The menopausal change is an important issue at any time in a woman’s life but women who are simultaneously dealing with a cancer diagnosis and treatment are even less prepared than older women. In ageing women, menopause is caused by a gradual shutting-down of the ovaries at the end of the reproductive years. With “the change,” the ovaries stop producing the hormones estrogen and progesterone. This hormonal withdrawal causes many of the symptoms of menopause. Young women undergoing a variety of cancer treatments may experience a sudden onset of menopause and its symptoms.
Chemotherapies that cause damage to the ovaries (and cause permanent or temporary infertility) can cause menopause. Some chemotherapies, such as those with alkylating agents, are more likely than others to increase the risk of infertility and menopause. In addition, radiation therapy to the pelvic areas or the brain can induce menopause by damaging the ovaries directly or disrupting the parts of the brain that control ovarian function. Women with ovarian cancer and some cases of breast cancer may have their ovaries surgically removed, which pushes them into a premature menopause termed “surgical menopause.” Some chemical methods of cancer prevention, such as tamoxifen, are prescribed to young women to reduce the risk for primary breast cancer or relapse. Tamoxifen works by interfering with estrogen signaling in the body that can increase the proliferation of cancerous cells but can also commonly cause menopausal side effects in women, though it does not cause menopause.
As with older women, symptoms for premature menopause due to cancer therapy may vary greatly between women. Cancer survivors with premature menopause experience a longer percentage of their lives without the natural protective effects of estrogens. These hormones are important for maintaining bone and heart health and cancer survivors may be at increased risks of long-term effects of premature menopause such as osteoporosis and cardiovascular disease. A new documentary, called Hot Flash Havoc, aims to explain some of these risks and includes interviews with women who experienced premature menopause in their 30s. The Institute for Women's Health Research is hosting an event with a panel of experts and pre-screening of the documentary on Wednesday, February 2nd in Chicago, IL.