OVACOME FACTSHEET 26 Treatment-induced Menopause: Facing the Issues What is the menopause?
▼ Combination drugs: increased toxicity to
The menopause is a natural hormonal process,during which tie the woman’s oestrogen levels
▼ Age: increased risk of ovaries failing over the
gradually fall, and there is an increase in follicle
age of 35. Younger women are also at risk,
stimulating and lutenising hormone. As a result,
the woman’s periods become irregular, and
▼ Fertility status/previous treatments: in general
eventually stop altogether. She may experience
physical and psychological changes and there is
years experience premature ovarian failure
a risk of osteoporosis and heart disease (see Table
The average age for the menopause is 50 years,
and a woman is described as post-menopausal
ovarian function before cancer treatment.
when her period has not returned for one year.
Some treatments for gynaecological cancer maylead to premature ovarian failure, and induce
▼ Both ovaries removed (bilateral oophorectomy): sudden onset of menopausal symptoms can occur post-operatively. Chemotherapy
▼ One ovary removed or simple hysterectomy:
Even when one ovary remains, there may be
The impact of various chemotherapeutic agents
an advance onset of the menopause, but does
▼ Type of drug used: some drugs are known to
▼ Oophoroplexy (moving the ovaries): Surgical
transposition may alter the blood supply to
▼ Dose: high dose increases risk of ovarian
used in the treatment of ovarian cancer. Short term/immediate symptoms Intermediate symptoms Long term risks Drugs with severe Drugs with moderate Drugs with less effect Drugs with unknown effects on ovaries effects on ovaries on ovaries effects on ovaries
Research on thesenewer drugs is limited. They are thought tohave a moderate effecton ovarian function,but there remains adegree of uncertaintyfor the women
▼ Pelvic radiotherapy: Ovaries are markedly
susceptible to radiation effects. But this is
natural benefits of oestrogen, she may wish to
give particular consideration to how she canmanage the change. There are many choices,
a) Radiation dosage: 2-3 fractions can results
and this article will focus on life style
in premature infertility and 10-13 fractions
management and non-hormonal management of
can induce an early onset menopause.
Symptoms may not always occurimmediately, more commonly occur within a
What can the woman do to help herself?
b) Women’s age: Radiation tolerance of the
ovaries is reduced over age 35 years, but all
symptoms, severity and duration will vary, and
women undergoing pelvic radiotherapy are at
chooses to try. Some of the choices are based on
What is a treatment induced
other women’s experiences of what they found
useful, and anecdotal evidence rather thanproven research trials.
This differs from a natural menopause, as there isa sudden rather than gradual change in hormone
levels as a direct side effect of cancer treatment.
How quickly this will occur can vary from
report, affecting four out of five women. They
woman to women, and also depends on the type
can occur at any age if oestrogen levels are
of treatment. For example, surgically removing
reduced, and vary in severity and duration.
the ovaries will have an immediate effect, butchemotherapy and radiotherapy can take several
▼ Keep a diary of your hot flushes: you may see
hot flushes at a particular time of day or in a
particular situation. You may be able to avoid
onset of symptoms, her period stops, and does
not return within a year. At a time when a
situations if you feel they exacerbate the
challenge relating to a cancer diagnosis, the
▼ Choose your clothes carefully: wear natural
treatment and its side effects, the overall impact
fabrics next to your skin rather than synthetic.
of the menopause may be exacerbated. The fact
Cotton night clothes and bed linen may be
more comfortable, particularly if you suffer
flushes, however, research has not proved
them more easily during a hot flush.
▼ Find ways to cool down quickly: keep a
reported benefits from this vitamin during the
bottle of iced water near you, use a spray
such as “evian spray mist”, and carry a small
research has not proved its suggested benefits
showers, and keepthe room well ventilated,
in reducing hot flushes. It is important that
particularly at night if prone to night sweats.
▼ Cut down on smoking (and if possible stop
vitamin B6, and it should only be taken in
completely): it is reported that the first puff of
each cigarette can trigger hot flushes.
packet). Side effects have been reported withhigh dose vitamin B6.
▼ Take regular exercise: it improves your
circulation, and may help manage or reduce
Clonidence (Dixarit): this form of medication
the intensity and frequency of hot flushes as
may reduce the severity and frequency of hot
the body adapts to coping with extremes of
flushes. Like all drugs, it may cause side-
effects: dry mouth, dizziness and nausea havebeen reported. Clonidine is being used less
▼ Limit foods and drinks which trigger your hot
flushes: this is individual to each woman. If
you note that certain foods and drinks trigger
hot flushes and night sweats, try to reduce
them in your diet. These may include spicy
Progesterone: this form of medication may be
prescribed to reduce or relieve hot flushes.
chocolate, alcohol, tea, coffee and soft drinks
Side effects may include abdominal bloating,
containing caffeine. Limiting hot drinks late
breast tenderness, increased appetite and
at night may help to reduce night sweats.
These affect the blood vessels, and may make
usually only prescribed short-term if being
used to treat hot flushes and it may not suitevery woman.
▼ Relaxation techniques: any exercises which
help you unwind and reduce stress may help
▼ Water based lubricants are recommended
listening to relaxing music or tapes may be
(available to buy over the counter), Replens
▼ Complementary therapies: therapies that may
Astraglide (available by mail order).
promote a feeling of well being during the
menopause, and may help you cope with thehot flushes are: aromatherapy, homeopathy,
The National Osteoporosis Society recommends
the following daily allowances of calcium:
acupuncture and yoga. It is essential that you
Menopausal woman without HRT – 1500 mg
consult a qualified therapist specialising in
the field, and also liaise with the doctortreating your cancer.
The body absorbs calcium from food better thanfrom calcium supplements.
▼ Taking gammalinolenic gcid (GLA): this is
found in evening primrose oil and efemast,
containing various amounts of GLA (which is
elendronate, are currently licensed for the
thought to be the active ingredient). Always
follow the instructions regarding daily dose
osteoporosis. Controlled clinical trials show they
on the label, or check with your doctor or
may offer long-term prevention of bone loss in
nurse. Many women have reported that theyhave found these oils useful in reducing hot
those who suffer from osteoporosis, by trying to
prevent the natural turnover of bone. The Amarant Trust
However, they are poorly absorbed and must not
medication or calcium supplement. Some womenmay find them difficult or inconvenient to take.
Reported side-effects include nausea, abdominal
The National Osteoporosis Society Etidronate (Didronel)
May be prescribed by a doctor, and is taken on a
90 day cycle. 400 mg etidronate disodium dailyfor 14 days, followed by 500 mg calcium
supplement for the next 76 days. The cycle is
The Women’s Nutritional Advisory Service
repeated and continued for a recommended three
years. It is taken with water or fruit juice, on anempty stomach two hours before food. Alendronate (fosamax) It is stronger than etidronate, and also needs to be Suggested reading The Natural Menopause
continuous basis. It needs to be taken with a full
Dr Mirian Stoppard. Dorling Kindersley. Cost
glass of water 30 minutes before breakfast, and
you need to remain upright for 30 minutes aftertaking each dose. Research has shown an
Is HRT Right for You?
increase in average bone mineral density with its
Dr Anne MacGregor. Sheldon Press. Cost £9.99
Understanding the Menopause Raloxifene (selective oestrogen receptor modulator) Understanding HRT and the Menopause
These are widely known as “SERMS”, and are the
Dr Robert CD Wilson, Which? Consumer Guide.
latest non-hormonal treatment to prevent bone
loss. Early research indicates that raloxifene mayprotect against cardiovascular disease and
Healthy Eating – A Guide for Cancer Patients
osteoporosis, with no known risk of causing
Hochland Communications Ltd, 0161 929 0190
cancer of the womb or breast. Raloxifene (one ofthe first “SERMS”) is now licensed for the
Overcoming Eating Difficulties
prevention of osteoporosis in the UK. However,
Hochland Communciations Ltd, 0161 929 0190
all the present SERMS can cause hot flushes and
The Menopause, HRT and You
sweats and there is no evidence that they willalleviate the other physical or psychological
symptoms that women may experience due to apremature menopause.
Liste des médicaments disponibles en libre service DÉNOMINATION COMMUNE INTERNATIONALE MÉDICAMENTS, PRÉSENTATION ET CONDITIONNEMENT PRIX PUBLIC MOYEN OBSERVÉ TTC (AVRIL 2008 – IMS HEALTH) Gastroentérologie (anti-acides) Alginate de sodium, bicarbonate de sodium, carbonate de calcium GAVISCONELL CPR A CROQUER CITRON 16 GAVISCONELL CPR A CROQUER CITRON 32 GAVISCO
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