(LifeWire) - Every year, approximately 276,000 women are diagnosed with breast cancer -- facing challenges, both physical and emotional. Approximately 25% of these women are diagnosed prior to menopause and may face an added challenge -- premature menopause.
What Is Premature Menopause?
Menopause refers to the point when a woman stops having menstrual periods. In the United States, women reach menopause, on average, at age 51. Ordinarily, this process -- known as the menopausal transition or perimenopause -- is gradual, often beginning when a woman is in her 40s. The symptoms of menopause, such as vaginal dryness, fatigue, and depression or anxiety, result from a decrease in estrogen production.
Certain breast cancer treatments produce similar symptoms, which can result in premature menopause. For example, women with specific genes linked to breast cancer (BRCA2 or BRCA2 mutations) are at high risk for ovarian cancer and may be advised to have their ovaries removed. Doing so means cessation of periods, leading to the symptoms commonly seen during menopause.
Symptoms And Signs of Premature Menopause
The main symptoms and signs of premature menopause are:
- Uncomfortable hot flashes and night sweats
- Bone loss (osteoporosis)
- Vaginal dryness, resulting in discomfort and painful intercourse
- Cardiovascular disease and an increased risk for heart attack and stroke
- Loss of fertility
What Is Distinctive About This Type Of Menopause?
Though women who experience premature menopause have the same symptoms as other menopausal women, theirs do not appear gradually. Rather, they can come on suddenly and with surprising severity.
Because such women experiencing premature menopause go largely without estrogen, they may be at increased risk for other health problems -- notably osteoporosis and cardiovascular disease -- against which estrogen offers some protection.
Who Experiences Premature Menopause?
Various factors affect whether a woman has premature menopause, including her age when treated, various family and genetic factors, her chemotherapy regimen (if any) and whether she receives continuous endocrine treatment (hormone therapy with pills or shots instead of surgery).
Weighing a number of factors can help women and their doctors predict who will avoid menopause, who will have a temporary cessation of periods, and who will face permanent menopause.
How Is It Treated?
Women with breast cancer are advised against taking estrogen-based medications for menopausal symptoms. To address symptoms, consider:
- Hot flashes: Dress in layers; use breathing exercises; consider trying the antidepressant Effexor (venlafaxine) or the antiseizure medication Neurontin (gabapentin)
- Bone loss: Calcium and vitamin D supplements; weight-bearing exercise; bisphosphonate medications (which counter osteoporosis)
- Vaginal dryness: Vaginal lubricants
- Cardiovascular disease: Maintain a healthy weight; eat healthy, low-fat foods; keep blood pressure and cholesterol down; get adequate exercise; quit smoking
- Loss of fertility: If you want biological children, consult a fertility specialist as soon as possible, preferably before starting cancer treatment
Why Seek Emotional Support?
A breast cancer diagnosis is bad enough. But confronting cancer and menopause multiplies the emotional issues, including one's sense of self, body image, and, of course, the potential loss of your ability to bear children. It only makes sense to reach out for support.
Is There Any Good News?
Actually, there is. It is clear that the very treatments that trigger premature menopause are responsible for today's vastly improved breast cancer survival rates. Some research suggests that women who enter premature menopause may actually fare better than other breast cancer patients because these treatments cut their lifetime exposure to estrogen. And -- in many cases -- estrogen plays a crucial role in the growth of breast cancer cells.
Women who hope to have children should speak with their oncologist and a fertility specialist as soon as possible. Significant advances have been made in fertility procedures. For example, a woman may be able to harvest eggs to freeze as eggs or embryos for future use. And adoption continues to be a wonderful gateway to parenthood.
Sources:
Abeloff, MD, et al. "Cancer of the Breast." Eds. MD Abeloff, et. al. Clinical Oncology. 3rd ed. 2004.
Deniz, G, et. al.. "Treatment of Premature Menopause in Breast Cancer Patients." Belgian Surgical Society. 107. 3. Jun. 2007. 263-266. (subscription)
Ganz, PA. "Breast Cancer, Menopause, and Long-Term Survivorship: Critical Issues for the 21st Century." The American Journal of Medicine. 118.12 (2005): 136-41. (subscription)
Knobf, MT. "'Coming to Grips With' Chemotherapy-Induced Premature Menopause." Health Care for Women International. 29. 4. Apr. 2008. 384-399. (subscription)
MacArthur, HL and CA Hudis. "Adjuvant Chemotherapy for Early-Stage Breast Cancer." Hematology/Oncology Clinics of North America. 21. 2. Apr. 2007. 207-222. (subscription)
Sonmezer M, and K. Oktay. "Fertility Preservation in Young Women Undergoing Breast Cancer Therapy." The Oncologist. 11. 5. May 2006. 422-434.
Stearns, V, et. al. "Breast Cancer Treatment and Ovarian Failure: Risk Factors and Emerging Genetic Determinants." Nature Reviews: Cancer. 6.11. Nov. 2006. 886-893. (subscription)
Suggested Reading:
Fertility and Chemotherapy
Breast Cancer Chemotherapy Drugs and Infertility
Intimacy After Breast Cancer Treatment Looking for a New "Normal"
Breast Cancer Treatment During Pregnancy
