Breast Cancer and Sudden Menopause
Currently, statistics show that one out of eight women in the United States will be diagnosed with breast cancer sometime in her lifetime. Except for skin cancer, breast cancer is the most common form of cancer experienced among women.
Fortunately, there are many treatments available for this widespread disease, and the 10-year survival rate is eighty-three percent. However, premenopausal women who are undergoing treatment for breast cancer often find themselves entering early menopause. This article reviews why this happens, and what indications it has for women moving forward.
What causes sudden menopause during breast cancer treatment?
Menopause symptoms experienced as a result of breast cancer treatment can be temporary or permanent. Conventional treatments for breast cancer include chemotherapy, hormone therapy, or ovarian suppression, in which case the function of your ovaries is either temporarily or permanently halted.
These cancer treatments can cause many women to experience menopause symptoms, as a result of an impaired ovarian function or other effects on reproductive hormones. While some premenopausal women will only experience menopausal symptoms and not truly enter menopause, many women will be considered menopausal after cancer treatment.
Typical hormone therapy for women who are estrogen receptor positive includes common drugs like tamoxifen, anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara). Being estrogen receptor positive means that your cancer is stimulated to grow by estrogen. Using endocrine hormone therapy stops the hormones from accessing the cancer cells, which can slow tumor growth, and the cells may die. Endocrine hormone therapy may reduce the risk of breast cancer coming back after surgery, reduce the size of your cancer before surgery to remove it, or to treat breast cancer that has come back or spread. The downside is that these drugs can cause menopausal symptoms like hot flashes, night sweats, and joint pain.
Chemotherapy may cause your periods to stop due to its impact on your ovaries and the production of estrogen. When this occurs, it can trigger menopausal symptoms. If the cessation of your periods is temporary from chemotherapy, your menopausal symptoms should improve when your menstrual cycle resumes.
Deliberate ovarian suppression may also be part of the treatment plan. Ovarian suppression stops the ovaries from making estrogen, either temporarily or permanently. Another term for this is ovarian ablation. Ovarian suppression can include the use of therapies like goserelin (Zoladex) or leuprolide (Lupron), hormones, ovarian removal surgery, and ovarian radiotherapy. These therapies can cause a sudden onset of menopause symptoms, which can be more intense than naturally occurring menopause.
Many women struggle with sudden menopause. Unlike women who undergo natural menopause and typically have a few years advance warning of signs and symptoms during perimenopause, women who experience the sudden onset of menopause usually have little preparation.
Some of the most common menopausal symptoms will include hot flashes, abdominal weight gain, night sweats, vaginal dryness, heart palpitations, mood changes, joint pain, and changes to skin and hair.
How is menopause managed when you have breast cancer?
Managing menopausal symptoms is important during breast cancer treatment, to help keep you as comfortable and healthy as possible. The most frequently reported symptoms are hot flashes and night sweats. You can lower the discomfort hot flashes and night sweats cause by having a room fan accessible, sleeping in a cool room, wearing loose and light clothing to bed, wearing layers throughout the day, and carrying a bottle of ice water with you.
Some of the most commonly used non-hormonal alternative therapies to help symptoms include acupuncture, aromatherapy, meditation, yoga, herbal remedies, and other activities. Sometimes complementary therapies work well in combination with other approaches
Many women find that cognitive-behavioral therapy (CBT) can be helpful. A CBT therapist can help you focus on improving your symptoms by working on how to improve your mindset to better deal with them and reduce anxiety. CBT may be most useful for the management of hot flashes and night sweats.
While hormone replacement therapy (HRT) is a common treatment for menopausal symptoms, it’s generally is not recommended for women with a history of breast cancer. There are many alternative non-hormonal medications to use for severe symptoms when they interfere with one’s quality of life.
Future risks and tips for coping
For some women, this forced onset of early menopause can be permanent, meaning they will become infertile. If having or adding to your family is something you had planned on, your doctor can discuss options for preserving fertility. Your options may include suppressing the ovaries, freezing eggs or embryos before treatment, and freezing whole ovaries or slices of ovarian tissue. These treatments are called oncofertility.
Coping with early menopause can be very hard. Dealing with persistent menopausal symptoms can be a difficult adjustment and can interfere with one’s quality of life. It’s essential to seek support and learn healthy ways of coping with these disappointments. If you don’t have close family or friends to lean on, it may be a good idea to seek out a support community, which you can often find online and within your own community. Taking care of your mental health is also imperative, so we strongly suggest finding a therapist who can help you grieve and cope in a healthy way.
Here are some resources for coping with breast cancer and the difficult side effects of treatment:
Dana-Farber Cancer Institute Fertility Preservation Program (for children and teens)
The Oncofertility Consortium at Northwestern University
Resolve The National Infertility Association
For more support during your unique menopause journey and how to deal with menopause symptoms non-hormonally, join the conversation over at Lisa Health.
Dr. Risa Kagan, MD, FACOG, CCD, NCMP is a leading clinician and researcher in Gynecology and Menopause. She is a board-certified obstetrician-gynecologist at Sutter Health and has been a Clinical Professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco for over 35 years. She is a North American Menopause Society (NAMS) Certified Menopause Practitioner (NCMP) and is certified by the International Society of Clinical Densitometry (CCD). She was previously co-medical director and principal investigator (PI) for multiple clinical trials at the Foundation for Osteoporosis Research and Education (FORE) in Oakland, CA, and now serves on the Medical and Scientific Advisory Board of American Bone Health (ABH). She is also a PI on numerous women’s health clinical research trials with the Jordan Research and Education Institute (REDI) of the Alta Bates Summit Medical Center, Sutter Health Research Institute. Dr. Kagan is the author or co-author of numerous publications in peer-reviewed journals and is on the editorial board of Menopause. She is often an ad hoc reviewer for many other journals including The Journal of Women’s Health and The Journal of Sexual Medicine. She specializes in gynecology with particular focus on gynecologic surgery and women's health issues including menopause, bone health, female sexuality, and female cancer survivorship. Dr. Kagan is regarded as one of the leading physicians in her field and has been nationally listed in US Best Doctors for many years. Dr. Kagan graduated from New York University and the Albany Medical College of Union University. She completed her internship-residency at the University of California San Francisco.